Healthcare Provider Details

I. General information

NPI: 1770546913
Provider Name (Legal Business Name): MITCHELL POLLAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 ROYAL PALM BLVD 105
CORAL SPRINGS FL
33065-5733
US

IV. Provider business mailing address

PO BOX 9007
CORAL SPRINGS FL
33075-9007
US

V. Phone/Fax

Practice location:
  • Phone: 954-345-6789
  • Fax: 954-345-7998
Mailing address:
  • Phone: 954-803-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberME0050840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: