MEDICARE: MISS MAKISHA POLLARD BS, MBA

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1891573341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MAKISHA POLLARD BS, MBA

Provider Business Mailing Address
First Line	:	13130 S SAINT LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60827-1344
Country	:	US
Telephone Number	:	773-368-1580
Fax Number	:

Provider Business Practice Location Address
First Line	:	10013 GRAND AVE
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-2546
Country	:	US
Telephone Number	:	847-861-7702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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