Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301035231 | MI |
N | 207QA0401X | Family Doctor - Addiction Medicine | 4301035231 | MI |
NPI | 1457525842 |
---|---|
Provider Name | Mr. Emery C Polasek |
First Address | Kalamazoo, MI 49008-1166 |
Second Address | Kalamazoo, MI 49008-1166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 16/04/2008 |