Provider Demographics
NPI:1003078007
Name:POLSAK, MICHOLEE BETH (DO)
Entity Type:Individual
Prefix:
First Name:MICHOLEE
Middle Name:BETH
Last Name:POLSAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MICHOLEE
Other - Middle Name:BETH
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD, 4070 DELP, MS 4017
Mailing Address - Street 2:KANSAS UNIVERSITY PHYSICIANS INC
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-2500
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD, 6040 DELP, MS 1020
Practice Address - Street 2:KANSAS UNIVERSITY PHYSICIANS INC
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-3974
Practice Address - Fax:913-588-6055
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05350404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine