Healthcare Provider Details

I. General information

NPI: 1710881123
Provider Name (Legal Business Name): POLIVICK MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WAUKEGAN RD STE 306
BANNOCKBURN IL
60015-1836
US

IV. Provider business mailing address

2101 WAUKEGAN RD STE 306
BANNOCKBURN IL
60015-1836
US

V. Phone/Fax

Practice location:
  • Phone: 847-807-1803
  • Fax: 847-221-6903
Mailing address:
  • Phone: 847-807-1803
  • Fax: 847-221-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. YASMIN POLIVICK
Title or Position: OWNER
Credential: MD
Phone: 312-582-0223