Provider Demographics
NPI:1821218256
Name:POLAKOFF, ROBERT I (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:POLAKOFF
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 1:1932 1ST AVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2498
Mailing Address - Country:US
Mailing Address - Phone:206-443-9379
Mailing Address - Fax:
Practice Address - Street 1:1932 1ST AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2498
Practice Address - Country:US
Practice Address - Phone:206-443-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000340512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABP5006362OtherDEA #
WABP5006362OtherDEA #
WA8856338Medicare ID - Type UnspecifiedCPC MEDICARE 4120
WA8856337Medicare ID - Type UnspecifiedCPC MEDICARE-NORTHGATE
WA8856332Medicare ID - Type UnspecifiedCPC MEDICARE BELLTOWN
WAG75349Medicare UPIN