Provider Demographics
NPI:1033144290
Name:POLMED PA
Entity Type:Organization
Organization Name:POLMED PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KASZUBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-216-0505
Mailing Address - Street 1:3890 TAMPA RD STE 404
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3675
Mailing Address - Country:US
Mailing Address - Phone:727-216-0505
Mailing Address - Fax:727-789-8261
Practice Address - Street 1:3890 TAMPA RD STE 404
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3675
Practice Address - Country:US
Practice Address - Phone:727-216-0505
Practice Address - Fax:727-789-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274663800Medicaid
FL274663800Medicaid