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General NPI Number Information
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NPI Number | 1861819765
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Entity Type | Individual
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Provider Name | ANTONIO R POLANCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 2950 CLEVELAND CLINIC BLVD
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City | WESTON
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State | FL
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Zip | 33331-3609
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Country | US
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Telephone | 347-514-1997
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-2704
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Fax |
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | D97217
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License Number State | MD
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