Provider Demographics
NPI:1881631257
Name:POLIT, ADRIAN MICHAEL (MD FFARCS)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:MICHAEL
Last Name:POLIT
Suffix:
Gender:M
Credentials:MD FFARCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119A S SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4111
Mailing Address - Country:US
Mailing Address - Phone:830-569-3397
Mailing Address - Fax:830-569-8686
Practice Address - Street 1:119A S SMITH ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4111
Practice Address - Country:US
Practice Address - Phone:830-569-3397
Practice Address - Fax:830-569-8686
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9966174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089762101Medicaid
TXC20566Medicare UPIN
TX089762101Medicaid