MEDICARE: GEORGEANN H POLANSKY 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	207VG0400X	Gynecology Physician	14579	AZ

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	:	1265422208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGEANN H POLANSKY MD

Provider Business Mailing Address
First Line	:	5601 W EUGIE AVE
Second Line	:	#100
City	:	GLENDAL
State	:	AZ
Zip	:	85304-1256
Country	:	US
Telephone Number	:	602-978-1500
Fax Number	:	602-978-0409

Provider Business Practice Location Address
First Line	:	5601 W EUGIE AVE
Second Line	:	#100
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1255
Country	:	US
Telephone Number	:	602-978-1500
Fax Number	:	602-978-0409

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	06/10/2008

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Directions to “ GEORGEANN H POLANSKY MD” Practice Location

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