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Individual

ROBERT J POLACEK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-2000
(859) 301-2066
Mailing address
PO BOX 636324, CINCINNATI, OH 45263-6324
(859) 344-5555
(859) 344-5552

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
28524
KY
207V00000X
Obstetrics & Gynecology Physician
Primary
28524
KY
208M00000X
Hospitalist Physician
28524
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000642753
ANTHEM BCBS PROVIDER #
KY
05
200194410
IN
05
2239554
OH
01
4198961
AETNA PROVIDER ID#
KY
05
64285240
KY
Enumeration date
05/31/2006
Last updated
08/31/2011
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