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General NPI Number Information
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NPI Number | 1659645083
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Entity Type | Organization
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Legal Business Name | CHARLES POLSEN MD PA LLC
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 2622 MARINA BAY DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-2758
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Country | US
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Telephone | 281-538-6600
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Fax | 281-535-2800
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Provider Business Mailing Address
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Address Line | 2622 MARINA BAY DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-2758
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Country | US
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Telephone | 281-538-6600
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Fax | 281-535-2800
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES POLSEN
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Credential | MD
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Telephone | 281-538-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | J2902
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License Number State | TX
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