Provider Demographics
NPI:1083684468
Name:CANAS-POLESEL, ADRIANA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:M
Last Name:CANAS-POLESEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1203 SMIZER MILL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3483
Mailing Address - Country:US
Mailing Address - Phone:636-717-1390
Mailing Address - Fax:636-717-1395
Practice Address - Street 1:1203 SMIZER MILL RD STE 106
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3483
Practice Address - Country:US
Practice Address - Phone:636-717-1390
Practice Address - Fax:636-717-1395
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004022976207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208785600Medicaid
MO208785600Medicaid
MO928465655Medicare PIN