Provider Demographics
NPI:1447652136
Name:YOURENCORE
Entity type:Organization
Organization Name:YOURENCORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL RESEARCH PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EMERY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:POLASEK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:269-204-6316
Mailing Address - Street 1:308 HYDER CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9587
Mailing Address - Country:US
Mailing Address - Phone:269-204-6316
Mailing Address - Fax:
Practice Address - Street 1:308 HYDER CIRCLE DR
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-9587
Practice Address - Country:US
Practice Address - Phone:269-204-6316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035231261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center