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General NPI Number Information
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NPI Number | 1639302078
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Entity Type | Individual
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Provider Name | MARINA POLUR M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 5323 MILLENIA LAKES BLVD SUITE 121
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City | ORLANDO
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State | FL
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Zip | 32839
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Country | US
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Telephone | 407-830-0414
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Fax |
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Provider Business Mailing Address
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Address Line | 725 N 12TH AVE
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City | ARCADIA
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State | FL
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Zip | 34266-8752
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Country | US
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Telephone | 239-936-5250
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Fax | 239-936-9970
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 72064
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME112727
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License Number State | FL
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