Provider Demographics
NPI:1225244668
Name:ELIZABETH POLACHECK MD SC
Entity Type:Organization
Organization Name:ELIZABETH POLACHECK MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:POLACHECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-727-8199
Mailing Address - Street 1:3033 W LAYTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2621
Mailing Address - Country:US
Mailing Address - Phone:414-727-8199
Mailing Address - Fax:888-371-8009
Practice Address - Street 1:3033 W LAYTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2621
Practice Address - Country:US
Practice Address - Phone:414-727-8199
Practice Address - Fax:888-371-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32041800Medicaid
02100Medicare ID - Type Unspecified