Provider Demographics
NPI:1477525806
Name:POLLACK, STEVEN ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALLEN
Last Name:POLLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1344
Mailing Address - Country:US
Mailing Address - Phone:561-368-2321
Mailing Address - Fax:561-368-1649
Practice Address - Street 1:1500 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1312
Practice Address - Country:US
Practice Address - Phone:561-368-2321
Practice Address - Fax:561-368-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44192207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61360Medicare PIN
FLD57209Medicare UPIN