Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 55429 | MN |
Y | 208600000X | Surgeon | 55429 | MN |
N | 2086S0120X | Pediatric Surgery | 55429 | MN |
NPI | 1356639652 |
---|---|
Provider Name | Stephanie F. Polites |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 02/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020003294 | (02) | MN |