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
Mailing address420 E Division St, Fond Du Lac, WI 54935-4560

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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