=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508180563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIPPOCRATESCONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2010
-----------------------------------------------------
Last Update Date | 09/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8852 KOSTNER TERRACE
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-1838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-675-1511
-----------------------------------------------------
Fax | 847-745-0139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8852 KOSTNER TERRACE
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-1838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-675-1511
-----------------------------------------------------
Fax | 847-745-0139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. RAYMOND POLLAK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 847-675-1511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 036057804
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------