Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Mark-Allen Nison Polyakov, MD

Individual provider Internal Medicine Physician · NPI 1548556053

Dr. Mark-Allen Nison Polyakov, MD is an Internal Medicine in Fond Du Lac, Wisconsin. Qualified in 2011, 15 years ago. Practices with Providence Medical Foundation, a 1,465-clinician group and accepts Medicare assignment. Licensed in California, Hawaii and Wisconsin.

Years since qualifying
15
Licensed in
CA, HI, WI
In the registry since
2011
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

430 E Division St
Fond Du Lac, WI 54935-4560
Phone: (920) 929-2300
Fax: (920) 926-4857
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Hospitalist Physician (primary) Taxonomy 208M00000X · Licence 69890 (WI)
Internal Medicine Physician Taxonomy 207R00000X · Licence 19068 (HI)
Internal Medicine Physician Taxonomy 207R00000X · Licence A132011 (CA)

Record details

NPI number1548556053
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 22, 2011
Last updated in NPPESApril 18, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Also practisesHOSPITALIST
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Providence Medical Foundation — 1465 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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