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NPI Code Detail

MEDICARE: JILL ELIZABETH POLK M.S.

MEDICARE: JILL ELIZABETH POLK M.S.
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
1170300000XGenetic Counselor (M.S.)

General Provider Information

NPI Number : 1689691602
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL ELIZABETH POLK M.S.
Provider Business Mailing Address
First Line : 6780 MAYFIELD RD
Second Line : HIRSCH CANCER CENTER
City : MAYFIELD HEIGHTS
State : OH
Zip : 44124-2203
Country : US
Telephone Number : 440-312-5634
Fax Number : 440-312-5652
Provider Business Practice Location Address
First Line : 6780 MAYFIELD RD
Second Line : HIRSCH CANCER CENTER
City : MAYFIELD HEIGHTS
State : OH
Zip : 44124-2203
Country : US
Telephone Number : 440-312-5634
Fax Number : 440-312-5652
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2006
Last Update Date : 07/08/2007

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