Healthcare Provider Details

I. General information

NPI: 1790887537
Provider Name (Legal Business Name): DAVID POLAK KINESIOTHERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

2S509 RIVER OAKS DR
WARRENVILLE IL
60555-1249
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-6389
  • Fax:
Mailing address:
  • Phone: 630-247-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: