Provider Demographics
NPI:1164593471
Name:POLLOCK, SAMUEL B JR (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:B
Last Name:POLLOCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 46
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-899-3858
Practice Address - Fax:502-899-3878
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY27788208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64277882Medicaid
IN100348420Medicaid
KYP400023981Medicare PIN
IN100348420Medicaid