Healthcare Provider Details

I. General information

NPI: 1861565111
Provider Name (Legal Business Name): KAREN M. POLEGA C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD DEPARTMENT OF ANESTHESIOLOGY
DETROIT MI
48202-2608
US

IV. Provider business mailing address

14500 HALL RD
STERLING HEIGHTS MI
48313-1229
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-7648
  • Fax:
Mailing address:
  • Phone: 586-247-6918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704113844
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: