=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730599366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT POLAK M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2014
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 MIAMISBURG CENTERVILLE RD STE 420
-----------------------------------------------------
City | MIAMISBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45342-7615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-439-4145
-----------------------------------------------------
Fax | 937-439-4371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 PRESTIGE PL STE 550
-----------------------------------------------------
City | MIAMISBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45342-6115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-762-1310
-----------------------------------------------------
Fax | 937-522-8068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | BP10049567
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 35.143165
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------