Healthcare Provider Details

I. General information

NPI: 1952860710
Provider Name (Legal Business Name): KELVIN L. POLLARD II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 SALT LICK RD
SAINT PETERS MO
63376-5974
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 636-387-4720
  • Fax: 636-387-4726
Mailing address:
  • Phone: 636-387-4720
  • Fax: 636-387-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022029188
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: