Provider Demographics
NPI:1609892801
Name:POLIAK, JORGE (MD)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:POLIAK
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 1:6200 WEST PARKER ROAD
Mailing Address - Street 2:BLDG 1 SUITE 406
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-378-3900
Mailing Address - Fax:972-378-3908
Practice Address - Street 1:6200 WEST PARKER ROAD
Practice Address - Street 2:BLDG 1 SUITE 406
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-378-3900
Practice Address - Fax:972-378-3908
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9965207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C20564Medicare UPIN
TX00GF62Medicare ID - Type Unspecified