Healthcare Provider Details

I. General information

NPI: 1629161484
Provider Name (Legal Business Name): JAMES DEAN POLLOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 GREEN BAY RD
WINNETKA IL
60093-1938
US

IV. Provider business mailing address

750 GREEN BAY RD
WINNETKA IL
60093-1938
US

V. Phone/Fax

Practice location:
  • Phone: 847-446-6310
  • Fax: 847-501-3432
Mailing address:
  • Phone: 847-446-6310
  • Fax: 847-501-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number#036-053336
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: