Provider Demographics
NPI:1295738490
Name:POLSLEY, J STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:J STEVEN
Middle Name:
Last Name:POLSLEY
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 1:900 SCIOTO ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-2251
Mailing Address - Country:US
Mailing Address - Phone:937-652-1834
Mailing Address - Fax:937-653-3476
Practice Address - Street 1:900 SCIOTO ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2251
Practice Address - Country:US
Practice Address - Phone:937-652-1834
Practice Address - Fax:937-653-3476
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH395120Medicaid
OHPO0475641Medicare ID - Type Unspecified
OH395120Medicaid