Provider Demographics
NPI:1184615049
Name:POLON, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:POLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1339 W 6TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2503
Practice Address - Country:US
Practice Address - Phone:814-877-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010615L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA166178OtherMEDPLUS
PA1012724380001Medicaid
PA8404212OtherCIGNA
PA310780OtherUPMC
PA166176OtherMEDPLUS
PA1691698536OtherHIGHMARK
PAP002206OtherGATEWAY
PA166176OtherUNISON
PA039319Medicare PIN
PA310780OtherUPMC
PA166178OtherMEDPLUS