Individual
DR. IRYNA VITALIYIVNA POLYAKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1201 S MAIN ST, CROWN POINT, IN 46307-8481
(219) 738-2100
(219) 933-2288
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02006069A
IN
207Q00000X
Family Medicine Physician
OS15044
FL
208M00000X
Hospitalist Physician
Primary
02006069A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JK466
FL MEDICARE
FL
01
—
P02211193
FL RR MEDICARE
FL
Enumeration date
07/09/2015
Last updated
10/16/2023
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