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General NPI Number Information
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NPI Number | 1225244668
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Entity Type | Organization
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Legal Business Name | ELIZABETH POLACHECK MD SC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 3033 W LAYTON AVE STE 201
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City | GREENFIELD
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State | WI
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Zip | 53221-2621
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Country | US
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Telephone | 414-727-8199
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Fax | 888-371-8009
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Provider Business Mailing Address
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Address Line | 3033 W LAYTON AVE STE 201
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City | GREENFIELD
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State | WI
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Zip | 53221-2621
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Country | US
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Telephone | 414-727-8199
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Fax | 888-371-8009
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ELIZABETH ANNE POLACHECK
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Credential | MD
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Telephone | 414-727-8199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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