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General NPI Number Information
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NPI Number | 1255832382
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Entity Type | Organization
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Legal Business Name | POLEY SPORTS MEDICINE, PLLC
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 15959 HALL RD STE 405
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City | MACOMB
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State | MI
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Zip | 48044
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Country | US
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Telephone | 586-416-6260
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Fax |
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Provider Business Mailing Address
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Address Line | 15959 HALL RD STE 405
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City | MACOMB
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State | MI
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Zip | 48044-5368
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Country | US
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Telephone | 586-416-6260
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ROBERT EDWARD POLEY
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Credential | MD
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Telephone | 586-416-6260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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