Provider Demographics
NPI:1669483046
Name:POLLY, DAVID W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:POLLY
Suffix:JR
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:2512 SOUTH 7TH STREET, SUITE R102
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-273-9400
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:2512 SOUTH 7TH STREET, SUITE R102
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34661207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
131005OtherUCARE
MN977595100Medicaid
IA0573717Medicaid
2032918OtherARAZ
ND10387Medicaid
SD7777470Medicaid
WI34466400Medicaid
09-00027OtherMEDICA PRIMARY
09-01282OtherMEDICA - CHOICE
1034987OtherPREFERREDONE
HP39572OtherHEALTHPARTNERS
MN354R8POOtherBLUECROSS BLUESHIELD
MN977595100Medicare ID - Type UnspecifiedMEDICARE
IA0573717Medicaid
09-00027OtherMEDICA PRIMARY