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NPI Code Detail

MEDICARE: ELIZABETH ANNE POLACHECK MD

MEDICARE: ELIZABETH ANNE POLACHECK 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
1208100000XPhysical Medicine & Rehabilitation Physician35784-20WI

Other Identifiers

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

General Provider Information

NPI Number : 1528115250
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ANNE POLACHECK MD
Provider Business Mailing Address
First Line : 1776 WOODSTEAD CT STE 208
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77380-1480
Country : US
Telephone Number : 877-749-7428
Fax Number :
Provider Business Practice Location Address
First Line : 1110 KEPLER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8306
Country : US
Telephone Number : 920-304-9695
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 12/03/2025

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Directions to “ ELIZABETH ANNE POLACHECK MD” Practice Location

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