Provider Demographics
NPI:1487648754
Name:POLISHUK, PAUL VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:VICTOR
Last Name:POLISHUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:332 S JUNIPER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4941
Mailing Address - Country:US
Mailing Address - Phone:760-291-6621
Mailing Address - Fax:760-737-3430
Practice Address - Street 1:215 S HICKORY ST
Practice Address - Street 2:SUITE 114
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4359
Practice Address - Country:US
Practice Address - Phone:760-743-5111
Practice Address - Fax:858-429-7934
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2020-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG84309208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G843090Medicaid
CAF95854Medicare UPIN
CAWG84309BMedicare PIN
CA00G843090Medicaid