Healthcare Provider Details

I. General information

NPI: 1760437727
Provider Name (Legal Business Name): JACEK M. POLSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR FL 1
MOBILE AL
36617-2300
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7790
  • Fax: 251-471-7096
Mailing address:
  • Phone: 251-434-3626
  • Fax: 251-445-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number23440
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: