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NPI Code Detail

MEDICARE: JOHN A. POLLASTRINI M.D.

MEDICARE: JOHN A. POLLASTRINI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036073402IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25723019OTHERBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1033131479
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN A. POLLASTRINI M.D.
Provider Business Mailing Address
First Line : PO BOX 2451
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61702-2451
Country : US
Telephone Number : 309-268-2172
Fax Number : 309-268-3649
Provider Business Practice Location Address
First Line : 1302 FRANKLIN AVE STE 1100
Second Line :
City : NORMAL
State : IL
Zip : 61761-0016
Country : US
Telephone Number : 309-268-2727
Fax Number : 309-268-6513
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 12/16/2021

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