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Individual

STANISLAV M POLIASHENKO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
10800 E GEDDES AVE STE 300, ENGLEWOOD, CO 80112-3895
(303) 761-9190
(720) 874-4462
Mailing address
10800 E GEDDES AVE STE 300, ENGLEWOOD, CO 80112-3895
(303) 761-9190
(720) 874-4462

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
6240
GA
2085R0202X
Diagnostic Radiology Physician
Primary
61493
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
111257135
MEDICARE
KS
01
832216
MEDICARE
CO
01
832218
MEDICARE
CO
01
832219
MEDICARE
CO
05
9000170766
CO
01
KA3249126
MEDICARE
KS
01
NA1214147
MEDICARE
NE
01
NA1215148
MEDICARE
NE
01
NA2517124
MEDICARE
NE
Enumeration date
04/22/2013
Last updated
03/31/2024
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