Provider Demographics
NPI:1053341412
Name:POLISSAINT, ELIE M (ARRT)
Entity type:Individual
Prefix:
First Name:ELIE
Middle Name:M
Last Name:POLISSAINT
Suffix:
Gender:M
Credentials:ARRT
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Mailing Address - Street 1:8190 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2047
Mailing Address - Country:US
Mailing Address - Phone:561-282-7672
Mailing Address - Fax:561-683-5787
Practice Address - Street 1:3630 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-1634
Practice Address - Country:US
Practice Address - Phone:561-282-7672
Practice Address - Fax:561-683-1932
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL623312471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography