MEDICARE: AUSTIN POLUTANOVICH

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	363LA2100X	Acute Care Nurse Practitioner	4704341665	MI

General Provider Information

NPI Number	:	1871339820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN POLUTANOVICH

Provider Business Mailing Address
First Line	:	1092 OREGON BLVD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-3345
Country	:	US
Telephone Number	:	810-394-1334
Fax Number	:

Provider Business Practice Location Address
First Line	:	6777 W MAPLE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3013
Country	:	US
Telephone Number	:	248-661-6466
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	01/19/2026

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