Provider Demographics
NPI:1396797205
Name:POLESKY, REESE EUGENE (MD)
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:EUGENE
Last Name:POLESKY
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 1:703 N CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3204
Mailing Address - Country:US
Mailing Address - Phone:310-273-1786
Mailing Address - Fax:310-858-7680
Practice Address - Street 1:703 N CAMDEN DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-3204
Practice Address - Country:US
Practice Address - Phone:310-273-1786
Practice Address - Fax:310-858-7680
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG6438207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA57526Medicare UPIN
CA0946420001Medicare NSC
CAWG6438BMedicare PIN