Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | #036-053336 | IL |
NPI | 1629161484 |
---|---|
Provider Name | Dr. James Dean Pollock |
First Address | Winnetka, IL 60093-1938 |
Second Address | Winnetka, IL 60093-1938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 07/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D12919 | (02) | IL |