Provider Demographics
NPI:1275913006
Name:POLANSKY, MAXIM ALEXANDROVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:ALEXANDROVICH
Last Name:POLANSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 264
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3844
Mailing Address - Country:US
Mailing Address - Phone:312-942-2195
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 264
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3844
Practice Address - Country:US
Practice Address - Phone:312-942-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-06
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73235207ND0101X
IL036159949207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery