Healthcare Provider Details

I. General information

NPI: 1093745879
Provider Name (Legal Business Name): CHARITY ANN POLLAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 S UTICA AVE STE 403
TULSA OK
74104-4015
US

IV. Provider business mailing address

1145 S UTICA AVE STE 403
TULSA OK
74104-4015
US

V. Phone/Fax

Practice location:
  • Phone: 918-960-2006
  • Fax: 918-900-1813
Mailing address:
  • Phone: 918-960-2006
  • Fax: 917-900-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22460
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: