Healthcare Provider Details

I. General information

NPI: 1841445640
Provider Name (Legal Business Name): NORRIS CARNELL POLK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 SAINT CLAIR ST
DETROIT MI
48214-3660
US

IV. Provider business mailing address

13334 E JEFFERSON AVE
DETROIT MI
48215-2719
US

V. Phone/Fax

Practice location:
  • Phone: 313-673-5970
  • Fax:
Mailing address:
  • Phone: 313-499-8812
  • Fax: 313-960-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48255
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: