Healthcare Provider Details

I. General information

NPI: 1912643099
Provider Name (Legal Business Name): JESSICA POLLARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W FRONT ST
TRAVERSE CITY MI
49684-8151
US

IV. Provider business mailing address

3601 W FRONT ST
TRAVERSE CITY MI
49684-8151
US

V. Phone/Fax

Practice location:
  • Phone: 231-946-1120
  • Fax: 231-946-8943
Mailing address:
  • Phone: 231-946-1120
  • Fax: 231-946-8943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5151015860
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: