Basic Information
| Provider Information | |||||||||
| NPI: | 1982658787 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLISKEY | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3009 N SAGINAW RD | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486404555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896331350 | ||||||||
| FaxNumber: | 9896331355 | ||||||||
| Practice Location | |||||||||
| Address1: | 3009 N SAGINAW RD | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486404555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896331350 | ||||||||
| FaxNumber: | 9896331355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 06/29/2012 | ||||||||
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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 | 4301407557 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.