Provider Demographics
NPI:1114913845
Name:POLYAK, VALENTINA (MD)
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:POLYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 TOWER CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3376
Mailing Address - Country:US
Mailing Address - Phone:847-623-3200
Mailing Address - Fax:847-623-9168
Practice Address - Street 1:45 TOWER CT
Practice Address - Street 2:SUITE C
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3376
Practice Address - Country:US
Practice Address - Phone:847-623-3200
Practice Address - Fax:847-623-9168
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-091687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42259Medicare UPIN