Provider Demographics
NPI:1235427949
Name:POLUN, BRENDAN JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:JOSEPH
Last Name:POLUN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10181 E FAIR CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5449
Mailing Address - Country:US
Mailing Address - Phone:719-457-6200
Mailing Address - Fax:303-363-5142
Practice Address - Street 1:1001 W MINERAL AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4507
Practice Address - Country:US
Practice Address - Phone:719-457-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0055455208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000147363Medicaid