Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 35.139315 | OH |
Y | 208200000X | Surgeon | 35.139315 | OH |
Y | 208600000X | Surgeon | 35.139315 | OH |
NPI | 1639285109 |
---|---|
Provider Name | Dr. John D Polousky |
First Address | Akron, OH 44308-1063 |
Second Address | Akron, OH 44308-1063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 18/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
353969401 | (05) | TX |
353969403 | (05) | TX |
I42604 | (02) |