Provider Demographics
NPI:1407177454
Name:POLAND, MAYNARD DILLON (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYNARD
Middle Name:DILLON
Last Name:POLAND
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 1:10648 SISTER BLUFF DR # 3C
Mailing Address - Street 2:
Mailing Address - City:SISTER BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54234-9081
Mailing Address - Country:US
Mailing Address - Phone:920-854-4650
Mailing Address - Fax:
Practice Address - Street 1:10648 SISTER BLUFF DR # 3C
Practice Address - Street 2:
Practice Address - City:SISTER BAY
Practice Address - State:WI
Practice Address - Zip Code:54234-9081
Practice Address - Country:US
Practice Address - Phone:920-854-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16266-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine