Provider Demographics
NPI:1770831158
Name:POLLAK, TAL (MD)
Entity Type:Individual
Prefix:
First Name:TAL
Middle Name:
Last Name:POLLAK
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 1:12094 NW 76TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4504
Mailing Address - Country:US
Mailing Address - Phone:954-240-8938
Mailing Address - Fax:
Practice Address - Street 1:12094 NW 76TH PL
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4504
Practice Address - Country:US
Practice Address - Phone:954-240-8938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60793-20207R00000X
WI60792-20208M00000X
IL036137445208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine