Healthcare Provider Details

I. General information

NPI: 1316915069
Provider Name (Legal Business Name): BARBARA POLSTEIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA POLSTEIN

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S SAN FRANSISCO ST BLDG 25 NAU CAMPUS
FLAGSTAFF AZ
86011-0001
US

IV. Provider business mailing address

824 S SAN FRANSISCO ST BLDG 25 NAU CAMPUS
FLAGSTAFF AZ
86011-0001
US

V. Phone/Fax

Practice location:
  • Phone: 928-523-2131
  • Fax: 928-523-1102
Mailing address:
  • Phone: 928-523-2131
  • Fax: 928-523-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3437
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: