MEDICARE: MICHELE POLON

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	207Q00000X	Family Medicine Physician	OS010615L	PA

General Provider Information

NPI Number	:	1184615049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE POLON

Provider Business Mailing Address
First Line	:	1339 W 6TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-2503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1339 W 6TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-2503
Country	:	US
Telephone Number	:	814-877-8170
Fax Number	:

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	03/25/2021

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Directions to “ MICHELE POLON ” Practice Location

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