Provider Demographics
NPI:1346280690
Name:POLES, MICHAEL ADAM (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ADAM
Last Name:POLES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 OVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-1033
Mailing Address - Country:US
Mailing Address - Phone:914-391-3710
Mailing Address - Fax:212-951-3481
Practice Address - Street 1:MANHATTAN VA HOSPITAL 423 EAST 23RD ST.
Practice Address - Street 2:ROOM 11097-S
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:212-951-3481
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY198245207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY198245OtherNYS LICENSE