Provider Demographics
NPI:1881680023
Name:POLNEROW, MICHAEL K (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:POLNEROW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4923 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:302-225-0451
Mailing Address - Fax:302-225-0472
Practice Address - Street 1:701 N CLAYTON ST STE 401
Practice Address - Street 2:ST. FRANCIS MEDICAL SERVICES BUILDING
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:302-421-9411
Practice Address - Fax:302-421-9460
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC2-0002419207RN0300X
MDH0038383207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD526271200Medicaid
DE0000104503Medicaid
NJ8818606Medicaid
DE001979N74Medicare PIN
MD036M800EMedicare PIN
NJ8818606Medicaid