Individual
KATHLEEN D POLONKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7525 E 82ND ST STE B, INDIANAPOLIS, IN 46256-1435
(317) 621-4600
(317) 621-4530
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
02004795A
IN
208000000X
Pediatrics Physician
5315060478
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201349120
—
IN
Enumeration date
06/20/2013
Last updated
11/27/2023
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