Basic Information
| Provider Information | |||||||||
| NPI: | 1801866462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLANSKY | ||||||||
| FirstName: | IRINA | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 LINCOLN PLACE CT STE 130 | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622215884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182571297 | ||||||||
| FaxNumber: | 6182571529 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 LINCOLN PLACE CT STE 130 | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622215884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182571297 | ||||||||
| FaxNumber: | 6182771190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085002586 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.