Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | ME0050840 | FL |
NPI | 1770546913 |
---|---|
Provider Name | Dr. Mitchell Pollak |
First Address | Coral Springs, FL 33075-9007 |
Second Address | Coral Springs, FL 33065-5733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 07/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D61000 | (02) | FL |