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General NPI Number Information
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NPI Number | 1508174079
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Entity Type | Individual
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Provider Name | TOM POLAKOW RN, BSN
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Gender | Male
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Dates
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Enumeration Date | 09/18/2010
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 850 FOLSOM ST STE B
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-1123
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Country | US
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Telephone | 415-723-2170
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Fax |
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Provider Business Mailing Address
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Address Line | 311 S BASSWOOD RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-2808
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 247217-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041386114
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License Number State | IL
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