Provider Demographics
NPI:1720519754
Name:POLEK, JAMES SAMUEL
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SAMUEL
Last Name:POLEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4653
Mailing Address - Country:US
Mailing Address - Phone:217-342-3400
Mailing Address - Fax:217-258-2216
Practice Address - Street 1:200 RICHMOND AVE E STE 4
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4652
Practice Address - Country:US
Practice Address - Phone:217-234-7000
Practice Address - Fax:217-238-5348
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4572207R00000X
IL036156024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine