Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 05350404 | KS |
Y | 111NI0900X | Internist | 05350404 | KS |
NPI | 1003078007 |
---|---|
Provider Name | Micholee Beth Polsak |
First Address | Kansas City, KS 66160 |
Second Address | Kansas City, KS 66160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 29/12/2014 |