Individual
MR. RONNIE POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3353 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-1455
(414) 559-6121
(141) 445-7858
Mailing address
4754 N 40TH ST, MILWAUKEE, WI 53209-5812
(414) 466-4101
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2931-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437325032
FEDERAL PROVIDER ID NUMBER
WI
Enumeration date
06/06/2009
Last updated
06/06/2009
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