Provider Demographics
NPI:1518128768
Name:POLACKWICH, ALAN SCOTT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SCOTT
Last Name:POLACKWICH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4306 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2840
Mailing Address - Country:US
Mailing Address - Phone:055-353-3493
Mailing Address - Fax:305-535-3438
Practice Address - Street 1:4300 ALTON RD STE 540
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2948
Practice Address - Country:US
Practice Address - Phone:305-674-2499
Practice Address - Fax:305-674-2899
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH123851208800000X
390200000X
FL124501208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program