Individual
THEODORE POLONUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
333 E ONTARIO ST APT 1703B, CHICAGO, IL 60611-4871
(312) 543-5780
Mailing address
333 E ONTARIO ST APT 1703B, CHICAGO, IL 60611-4871
(312) 543-5780
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUE CROSS
01673341
IL
Enumeration date
12/18/2006
Last updated
07/08/2007
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