Basic Information
| Provider Information | |||||||||
| NPI: | 1457525842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLASEK | ||||||||
| FirstName: | EMERY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 S WESTNEDGE AVE | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490081166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693444458 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1020 S WESTNEDGE AVE | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490081166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693444458 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301035231 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0401X | 4301035231 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 208U00000X | 4301035231 | MI | N | Allopathic & Osteopathic Physicians | Clinical Pharmacology |
No ID Information.