Polukhin, Elena L

Polukhin, Elena L is an individual health care provider with primary practice located at 3015 Utah Ave S Suite 200, Saint Louis Park MN 55426-3671. She recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as her primary health care specialty. Polukhin, Elena L can be contacted via phone (952) 933-1121.

Contact Information

Primary practice address
3015 Utah Ave S Suite 200 Saint Louis Park MN 55426-3671
Phone: (952) 933-1121
Fax: (952) 945-9536
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 45600 Minnesota

Profile Details

NPI number 1336187814
LBN Legal business name Polukhin, Elena L
Credentials MD, PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 4th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336187814 NPPES
Minnesota MEDICAID 630074000

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