Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 04-31441 | KS |
Y | 207T00000X | Neurosurgeon | 35.122856 | OH |
NPI | 1104917137 |
---|---|
Provider Name | Ania G Pollack |
First Address | Dayton, OH 45409-2939 |
Second Address | Dayton, OH 45409-2939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 06/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200335380A | (05) | KS |
207530403 | (05) | MO |
35914019 | BCBS KANSAS CITY (01) | MO |
927663 | FIRSTGUARD (01) | KS |
I42665 | (02) |