Provider Demographics
NPI:1811007404
Name:POLITO-COLVIN, JUANITA (MD)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:POLITO-COLVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:
Other - Last Name:POLITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:226 S WOODS MILL RD STE 32W
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3442
Mailing Address - Country:US
Mailing Address - Phone:314-576-1616
Mailing Address - Fax:314-576-5271
Practice Address - Street 1:226 S WOODS MILL RD STE 32W
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3442
Practice Address - Country:US
Practice Address - Phone:314-576-1616
Practice Address - Fax:314-576-5271
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics