Healthcare Provider Details

I. General information

NPI: 1902068604
Provider Name (Legal Business Name): JAMES D. POLLOCK, MD,SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
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 Number036-053336
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES POLLOCK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-446-6310