Provider Demographics
NPI:1265400709
Name:POLSKY, MARK D (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:POLSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 SW MARTIN HWY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3222
Mailing Address - Country:US
Mailing Address - Phone:772-324-9337
Mailing Address - Fax:772-324-9347
Practice Address - Street 1:2351 SW MARTIN HWY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3222
Practice Address - Country:US
Practice Address - Phone:772-324-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80656OtherBCBS
FL119193400Medicaid
FLF07756Medicare UPIN