Anthony Polazzo

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601001008 Issued in MI

Practice address

2300 Plymouth Ave SE
Grand Rapids, MI 49506-5225

Phone

(616) 574-5828

NPI assigned

Oct 14, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522108800000",
    "number": "1801290309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 BAYBERRY POINTE DR NW APT F",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495344611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 PLYMOUTH AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495065225",
            "telephone_number": "616-574-5828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1311 Chicago Ave",
            "address_2": "Apt 105",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602014760",
            "country_code": "US",
            "telephone_number": "715-923-4481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLAZZO",
        "first_name": "ANTHONY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-14",
        "last_updated": "2018-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601001008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cara Anne Poland, M.D.
• Michelle Kristine Polanic
• Karly Aaron Polash
• Erika Lyn Polaski, DIPLOMA
• Latha Sree Polavaram, MD
• James Robert Polega, MD
• Madison Polen, PT
• Victoria A Poleni, MSW
• Jennifer Marie Poling, LMSW
• Carolyn Polinice

• Athletic Trainer in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.