Provider Demographics
NPI:1336552496
Name:POLACEK, SARAH A (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:POLACEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:SOLTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9002 N MERIDIAN ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5380
Mailing Address - Country:US
Mailing Address - Phone:317-819-4516
Mailing Address - Fax:317-819-0044
Practice Address - Street 1:5255 E STOP 11 RD
Practice Address - Street 2:SUITE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6340
Practice Address - Country:US
Practice Address - Phone:317-844-7059
Practice Address - Fax:317-819-0044
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001670A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN267650012Medicare PIN