Individual
ENRIQUE D POLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1223 GATEWAY DR, MELBOURNE, FL 32901-2607
(321) 312-3487
(321) 956-2542
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME89353
FL
207RC0001X
Clinical Cardiac Electrophysiology Physician
ME894353
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274442200
—
FL
01
—
41003
BCBS OF FL
FL
01
—
7388727
AETNA
—
01
—
P00382944
RR MEDICARE
FL
01
—
P01164167
FL RR MEDICARE
FL
01
—
U6951W
HFMG MEDICARE
FL
Enumeration date
05/17/2006
Last updated
01/02/2025
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