Provider Demographics
NPI:1164436192
Name:POLIT, TAMMY L (DO)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:POLIT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-6360
Mailing Address - Fax:317-621-6367
Practice Address - Street 1:6910 HILLSDALE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2040
Practice Address - Country:US
Practice Address - Phone:317-621-6337
Practice Address - Fax:317-621-6366
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001561A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100386940Medicaid
IN000000312841OtherANTHEM
IN100386940Medicaid
IN214190BMedicare PIN
INP00224530Medicare PIN
IN214180IMedicare PIN
INM400040686Medicare PIN