Provider Demographics
NPI:1053956912
Name:POLEKI, TUSI
Entity type:Individual
Prefix:
First Name:TUSI
Middle Name:
Last Name:POLEKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3476 W 7625 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-4510
Mailing Address - Country:US
Mailing Address - Phone:385-229-6467
Mailing Address - Fax:
Practice Address - Street 1:9045 S 1300 E STE 200
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3134
Practice Address - Country:US
Practice Address - Phone:801-666-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker