Provider Demographics
NPI:1598226615
Name:JOSE, JOSEPH MEKKATTUKULAM (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MEKKATTUKULAM
Last Name:JOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E OHIO ST STE 118
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2145
Mailing Address - Country:US
Mailing Address - Phone:419-296-1470
Mailing Address - Fax:
Practice Address - Street 1:830 W HIGH ST STE 390
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3988
Practice Address - Country:US
Practice Address - Phone:419-226-9610
Practice Address - Fax:419-226-9602
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01087918A207R00000X
OH390200000X
OH35.145135207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program