Healthcare Provider Details

I. General information

NPI: 1568983765
Provider Name (Legal Business Name): HAIDEE MAURA POLGAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 PARK ST STE 200
NAPERVILLE IL
60563-8404
US

IV. Provider business mailing address

3107 ANTON DR
AURORA IL
60504-6665
US

V. Phone/Fax

Practice location:
  • Phone: 630-486-3664
  • Fax: 630-984-7427
Mailing address:
  • Phone: 331-725-1532
  • Fax: 630-984-7427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.016112
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.016112
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: