Healthcare Provider Details

I. General information

NPI: 1114150232
Provider Name (Legal Business Name): TREVOR NICHOLAS POLLOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-5589
  • Fax: 734-763-4208
Mailing address:
  • Phone: 734-763-5589
  • Fax: 734-763-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301105503
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: