Provider Demographics
NPI:1497833719
Name:POLLACK, NEAL HOWARD (DO)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:HOWARD
Last Name:POLLACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N MAYFAIR RD STE 1120
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1308
Mailing Address - Country:US
Mailing Address - Phone:414-453-7780
Mailing Address - Fax:414-453-4296
Practice Address - Street 1:2600 N MAYFAIR RD STE 1120
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1308
Practice Address - Country:US
Practice Address - Phone:414-453-7780
Practice Address - Fax:414-453-4296
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI198412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391257949019OtherBLUE CROSS & BLUE SHEID
WI30033300Medicaid
WI000101447Medicare PIN
WI30033300Medicaid