Provider Demographics
NPI:1629161484
Name:POLLOCK, JAMES DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEAN
Last Name:POLLOCK
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 1:750 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1938
Mailing Address - Country:US
Mailing Address - Phone:847-446-6310
Mailing Address - Fax:847-501-3432
Practice Address - Street 1:750 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1938
Practice Address - Country:US
Practice Address - Phone:847-446-6310
Practice Address - Fax:847-501-3432
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL#036-053336207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12919Medicare UPIN
IL#484520Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER