Individual
DR. MARK-ALLEN NISON POLYAKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-2300
(920) 926-4857
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
19068
HI
207R00000X
Internal Medicine Physician
A132011
CA
208M00000X
Hospitalist Physician
Primary
69890
WI
Other
Enumeration date
06/22/2011
Last updated
04/18/2019
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