Provider Demographics
NPI:1356315303
Name:POLAKOFF, RICHARD BARRY (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BARRY
Last Name:POLAKOFF
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 1:4850 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 143
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7260
Mailing Address - Country:US
Mailing Address - Phone:954-676-9980
Mailing Address - Fax:954-676-5288
Practice Address - Street 1:4850 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 143
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7260
Practice Address - Country:US
Practice Address - Phone:954-676-9980
Practice Address - Fax:954-676-5288
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046546207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37534900Medicaid
FL03641Medicare ID - Type Unspecified
FL37534900Medicaid