Provider Demographics
NPI:1134189970
Name:CHEN, POLO (MD)
Entity type:Individual
Prefix:
First Name:POLO
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13301 MAPLE KNOLL WAY
Mailing Address - Street 2:UNIT 614
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:612-275-9288
Mailing Address - Fax:
Practice Address - Street 1:4050 COON RAPIDS BLVD
Practice Address - Street 2:UNIT 4 WEST, PEDIATRIC HOSPITALIST
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:763-236-9765
Practice Address - Fax:763-236-7422
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47318208000000X
WI490212080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I50440Medicare UPIN