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General NPI Number Information
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NPI Number | 1710881123
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Entity Type | Organization
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Legal Business Name | POLIVICK MEDICAL PLLC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 2101 WAUKEGAN RD STE 306
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City | BANNOCKBURN
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State | IL
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Zip | 60015-1836
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Country | US
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Telephone | 847-807-1803
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Fax | 847-221-6903
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Provider Business Mailing Address
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Address Line | 2101 WAUKEGAN RD STE 306
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City | BANNOCKBURN
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State | IL
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Zip | 60015-1836
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Country | US
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Telephone | 847-807-1803
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Fax | 847-221-6903
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Authorized Official
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Title or Position | OWNER
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Name | DR. YASMIN POLIVICK
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Credential | MD
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Telephone | 312-582-0223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | NULL
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