MEDICARE: DR. ADRIANA M CANAS-POLESEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	2004022976	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083684468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIANA M CANAS-POLESEL MD

Provider Business Mailing Address
First Line	:	1203 SMIZER MILL RD STE 106
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-3483
Country	:	US
Telephone Number	:	636-717-1390
Fax Number	:	636-717-1395

Provider Business Practice Location Address
First Line	:	1203 SMIZER MILL RD STE 106
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-3483
Country	:	US
Telephone Number	:	636-717-1390
Fax Number	:	636-717-1395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	02/15/2012

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