Individual
MICHAEL D POLKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(920) 731-4101
Mailing address
4930 N TURNBERRY DR, APPLETON, WI 54913-8680
(815) 315-2318
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-108682
IL
207P00000X
Emergency Medicine Physician
Primary
53394
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036108682
—
IL
05
—
34715700
—
WI
01
—
P00054858
MEDICARE RAILROAD
IL
Enumeration date
07/24/2006
Last updated
02/09/2017
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