Healthcare Provider Details

I. General information

NPI: 1750219424
Provider Name (Legal Business Name): CONNOR AARON POLSINELLI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE M-510
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN STREET BOX 42
KALAMAZOO MI
49007-5232
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-7762
  • Fax: 269-341-8098
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704388861
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: