Provider Demographics
NPI:1306979158
Name:POLO, MAX L (MD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:L
Last Name:POLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6280 SUNSET DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4827
Mailing Address - Country:US
Mailing Address - Phone:305-666-1352
Mailing Address - Fax:305-667-8709
Practice Address - Street 1:6280 SUNSET DR
Practice Address - Street 2:SUITE 501
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4827
Practice Address - Country:US
Practice Address - Phone:305-666-1352
Practice Address - Fax:305-667-8709
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
FLME70606208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH44682Medicare UPIN
FL58752Medicare ID - Type UnspecifiedMEDICARE NUMBER