Individual
JORGE R POLETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
(708) 681-0073
(708) 681-3958
Mailing address
1414 MAIN ST, MELROSE PARK, IL 60160-3902
(708) 681-0073
(708) 681-3958
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
987654321
—
IL
Enumeration date
08/02/2011
Last updated
08/02/2011
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