Provider Demographics
NPI:1699034405
Name:MARTIN J POLLAK MD SC
Entity Type:Organization
Organization Name:MARTIN J POLLAK MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLLAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-297-2091
Mailing Address - Street 1:9301 GOLF RD
Mailing Address - Street 2:300
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016
Mailing Address - Country:US
Mailing Address - Phone:847-297-2091
Mailing Address - Fax:847-297-2060
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:300
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:847-297-2091
Practice Address - Fax:847-297-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036037460207Y00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty