Provider Demographics
NPI:1619967858
Name:PAULOSKI, JEFFREY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:PAULOSKI
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 1:13914 SOUTHEASTERN PARKWAY
Mailing Address - Street 2:SUITE 314
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7127
Mailing Address - Country:US
Mailing Address - Phone:317-872-1415
Mailing Address - Fax:317-773-5945
Practice Address - Street 1:13914 SOUTHEASTERN PKWY
Practice Address - Street 2:SUITE 314
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7127
Practice Address - Country:US
Practice Address - Phone:317-872-1415
Practice Address - Fax:317-773-5945
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037714A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100357700Medicaid
INF35873Medicare UPIN
IN151560O5Medicare PIN
IN152410HHMedicare PIN
INP00022780Medicare PIN
IN677690FMedicare PIN
IN160054112Medicare PIN