Provider Demographics
NPI:1215561295
Name:POLASEK, RACHEL M (PA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:POLASEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MURANN
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2935
Mailing Address - Country:US
Mailing Address - Phone:361-643-6623
Mailing Address - Fax:
Practice Address - Street 1:107 CEDAR DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2935
Practice Address - Country:US
Practice Address - Phone:361-643-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA134582084N0400X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX408586201Medicaid
TX408586202OtherCSHCN