Provider Demographics
NPI:1992780811
Name:POLAS, PHYLLIS J (DO)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:J
Last Name:POLAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 NIKE DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9081
Mailing Address - Country:US
Mailing Address - Phone:614-529-4260
Mailing Address - Fax:614-529-4270
Practice Address - Street 1:5510 NIKE DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9081
Practice Address - Country:US
Practice Address - Phone:614-529-4260
Practice Address - Fax:614-529-4270
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2036184Medicaid
OH2036184Medicaid