| Stanley M Poleck Do Pllc | |
|
19335 Grand River Ave Detroit MI 48223-1201 | |
| (313) 794-8780 | |
| Not Available |
| Full Name | Stanley M Poleck Do Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 19335 Grand River Ave, Detroit, Michigan |
| Authorized Official Name and Position | Annemarie Poleck (OWNER) |
| Authorized Official Contact | 3137948780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stanley M Poleck Do Pllc 19335 Grand River Ave Detroit MI 48223-1201 Ph: () - | Stanley M Poleck Do Pllc 19335 Grand River Ave Detroit MI 48223-1201 Ph: (313) 794-8780 |
| NPI Number | 1083759567 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 04/03/2020 |
| Medicare PECOS PAC ID | 1153491873 |
|---|---|
| Medicare Enrollment ID | O20080605000816 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083759567 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5101006113 (Michigan) | Primary |
| Provider Name | Annemarie Catherine Poleck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699851519 PECOS PAC ID: 5799713236 Enrollment ID: I20051116000502 |
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