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General NPI Number Information
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NPI Number | 1841445640
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Entity Type | Individual
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Provider Name | NORRIS CARNELL POLK M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 790 SAINT CLAIR ST
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City | DETROIT
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State | MI
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Zip | 48214-3660
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Country | US
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Telephone | 313-673-5970
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Fax |
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Provider Business Mailing Address
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Address Line | 13334 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48215-2719
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Country | US
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Telephone | 313-499-8812
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Fax | 313-960-8480
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 48255
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License Number State | MI
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