Provider / Organization | NPI | Date Certified |
---|---|---|
JOTHIS C JOSE | 1306130737 | 2023-11-10 |
Jothis C Jose [M] graduated in 2011 and primarily specializes in Family Medicine.
Jothis C Jose is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1306130737. Registration indicates Jothis C Jose is a provider of access to adult/geriatric primary care providers services with a specialization in Allopathic & Osteopathic Physicians, Family Medicine Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, Family Medicine) (Allopathic & Osteopathic Physicians, Family Medicine) (Family Medicine, ) (Primary Care/Family Planning/APRN/PA, ) (Family Medicine, Allopathic & Osteopathic Physicians)
PECOS ID | 6608098355 |
Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
Entity Type | Individual |
Provider Name | Jothis C Jose M.D. |
Practice Office Address | 200 E RYAN RD OAK CREEK, WI US |
Practice Office Telephone | 4145703590 |
Mailing Address | PO BOX 735044 CHICAGO, IL 606735044 US |
FHIR URL [] | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ | |
Direct Messaging Address [] | [email protected] | Direct |
Code | Practice | License No State |
---|---|---|
207Q00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Allopathic & Osteopathic Physicians Family MedicineAccess to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians Family Medicine Allopathic & Osteopathic Physicians Family Medicine Family Medicine Primary Care/Family Planning/APRN/PA Family Medicine Allopathic & Osteopathic Physicians | 62540
WI |
100040107 | MEDICAID | WI |