Provider Demographics
NPI:1104038629
Name:POLEY, ROBERT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:POLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1701 SOUTH BLVD E STE 140
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6118
Mailing Address - Country:US
Mailing Address - Phone:248-792-9881
Mailing Address - Fax:248-430-5375
Practice Address - Street 1:1701 SOUTH BLVD E STE 140
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6118
Practice Address - Country:US
Practice Address - Phone:248-792-9881
Practice Address - Fax:248-430-5375
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088761207QS0010X
MI4301081773207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine