Provider Demographics
NPI:1760437727
Name:POLSKI, JACEK M (MD)
Entity Type:Individual
Prefix:
First Name:JACEK
Middle Name:M
Last Name:POLSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DR FL 1
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2300
Practice Address - Country:US
Practice Address - Phone:251-471-7790
Practice Address - Fax:251-471-7096
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL23440207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932350Medicaid
AL11-00206OtherUNITED HEALTH CARE
LA1430480Medicaid
MS00122325Medicaid
AL009932340Medicaid
FL260555400Medicaid
AL51097767OtherBLUE CROSS
AL51097771OtherBLUE CROSS
MS00122325Medicaid