Doctor Name: | MR. ROBERT R POLFUS |
NPI Number: | 1649308040 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | |
Business Practice Address: | 533 Peace Pipe Road Lac Du Flambeau, WI - 545380189 |
Business Phone Number: | 7155881511 |
Business Fax Number: | 7155883903 |
Mailing Address: | 533 Peace Pipe Road, P.o. Box 189 LAC DU FLAMBEAU |
State: | WI |
Postal Code: | 545380189 |
Phone Number: | 7155881511 |
Fax Number: | 7155883903 |
NPI Enumeration Date: | 02/28/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |