Provider Demographics
NPI:1578598694
Name:POLISKY, ROBERT B (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:POLISKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:901 BIESTERFIELD RD
Mailing Address - Street 2:#209
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3392
Mailing Address - Country:US
Mailing Address - Phone:847-593-6222
Mailing Address - Fax:
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:#209
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3392
Practice Address - Country:US
Practice Address - Phone:847-593-6222
Practice Address - Fax:847-593-0097
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL06799Medicare PIN
ILD15895Medicare UPIN