Provider Demographics
NPI:1528077740
Name:POLITOSKE, DOUGLAS ANDREW (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:POLITOSKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 FROST ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4205
Mailing Address - Country:US
Mailing Address - Phone:858-292-7527
Mailing Address - Fax:858-292-7804
Practice Address - Street 1:8008 FROST ST
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4205
Practice Address - Country:US
Practice Address - Phone:858-292-7527
Practice Address - Fax:858-292-7804
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52965207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0027570Medicaid
E97733Medicare UPIN
CAW10354Medicare ID - Type Unspecified