MEDICARE: MEDICAL POLIS P.C.

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	207R00000X	Internal Medicine Physician	233906	NY

General Provider Information

NPI Number	:	1295929701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL POLIS P.C.

Provider Business Mailing Address
First Line	:	PO BOX 747896
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11374-7896
Country	:	US
Telephone Number	:	848-203-9608
Fax Number	:

Provider Business Practice Location Address
First Line	:	2639 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2407
Country	:	US
Telephone Number	:	718-385-1115
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NIKOLAI LAGODUKE
Credential	:	M.D.
Telephone Number	:	848-203-9608

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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