Provider Demographics
NPI:1457370918
Name:JOHN, PAULOSE S (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULOSE
Middle Name:S
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:651-641-6205
Practice Address - Street 1:2500 COMO AVENUE
Practice Address - Street 2:MS31100A HEALTHPARTNERS COMO CLINIC
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1460
Practice Address - Country:US
Practice Address - Phone:651-641-6200
Practice Address - Fax:651-641-6205
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-03-03
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Provider Licenses
StateLicense IDTaxonomies
MN53916207Q00000X
MA226723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine