Provider Demographics
NPI:1003938374
Name:POLINA NOSEL MD,PA
Entity Type:Organization
Organization Name:POLINA NOSEL MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-945-8111
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR
Mailing Address - Street 2:SUITE 275
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4707
Mailing Address - Country:US
Mailing Address - Phone:305-945-8111
Mailing Address - Fax:305-945-8186
Practice Address - Street 1:1380 NE MIAMI GARDENS DR
Practice Address - Street 2:SUITE 275
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4707
Practice Address - Country:US
Practice Address - Phone:305-945-8111
Practice Address - Fax:305-945-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76939261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1384Medicare ID - Type Unspecified
FLG81818Medicare UPIN