Provider Demographics
NPI:1851435283
Name:POLLARD, CHARLES RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RUSSELL
Last Name:POLLARD
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 1:300 S RATH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-3003
Mailing Address - Country:US
Mailing Address - Phone:231-843-2543
Mailing Address - Fax:
Practice Address - Street 1:300 S RATH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-3003
Practice Address - Country:US
Practice Address - Phone:231-843-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICP038083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0805336581OtherBCBSM
MI2100810Medicaid
MI0533658Medicare ID - Type UnspecifiedID