Provider Demographics
NPI:1497131619
Name:POLOMIK, MICHAEL (CPED, CFO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:POLOMIK
Suffix:
Gender:M
Credentials:CPED, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 TRAPPERS RUN DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1031 W WILLIAMS ST
Practice Address - Street 2:SUITE 104
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3955
Practice Address - Country:US
Practice Address - Phone:919-267-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
CPED4253224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist