Provider Demographics
NPI:1902966690
Name:POLENAKOVIK, HARI MOMIR (MD)
Entity Type:Individual
Prefix:MR
First Name:HARI
Middle Name:MOMIR
Last Name:POLENAKOVIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435-0001
Mailing Address - Country:US
Mailing Address - Phone:937-245-7100
Mailing Address - Fax:937-245-7999
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2684
Practice Address - Country:US
Practice Address - Phone:937-223-5350
Practice Address - Fax:937-224-3112
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-4531-P207RI0200X
OH35.074531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2207301Medicaid
H33829Medicare UPIN
OH2207301Medicaid
OHPO4045344Medicare PIN