Provider Demographics
NPI:1578827184
Name:POLECRITTI, DEREK CHASE (DO)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:CHASE
Last Name:POLECRITTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1111 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2613
Mailing Address - Country:US
Mailing Address - Phone:515-643-2261
Mailing Address - Fax:515-643-5802
Practice Address - Street 1:10429 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5043
Practice Address - Country:US
Practice Address - Phone:352-556-5248
Practice Address - Fax:352-556-5249
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS16037208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery