MEDICARE: VINCENT POLICH PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9101059	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134238124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT POLICH PA

Provider Business Mailing Address
First Line	:	2600 LAKE LUCIEN DR STE 180
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7235
Country	:	US
Telephone Number	:	407-875-2080
Fax Number	:	407-875-0518

Provider Business Practice Location Address
First Line	:	1410 W BROADWAY ST STE 205
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6472
Country	:	US
Telephone Number	:	407-359-2100
Fax Number	:	407-359-5445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ VINCENT POLICH PA” Practice Location

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