Provider Demographics
NPI:1568459048
Name:POLANCO, ROBERTO CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:CESAR
Last Name:POLANCO
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:PO BOX 655009
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-5009
Mailing Address - Country:US
Mailing Address - Phone:305-228-4422
Mailing Address - Fax:305-221-4848
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:416
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3582
Practice Address - Country:US
Practice Address - Phone:305-228-4422
Practice Address - Fax:305-221-4848
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62015174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF26921Medicare UPIN
FL14922PMedicare PIN