MEDICARE: ROBERT A POLLOCK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	27959	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407849391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT A POLLOCK MD

Provider Business Mailing Address
First Line	:	PO BOX 496
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-0496
Country	:	US
Telephone Number	:	952-738-1420
Fax Number	:

Provider Business Practice Location Address
First Line	:	4570 JEWEL LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-2448
Country	:	US
Telephone Number	:	952-738-1420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	06/23/2021

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