Provider Demographics
NPI:1851509277
Name:POLLACHEK, PAUL C (RN,BS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:POLLACHEK
Suffix:
Gender:M
Credentials:RN,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 PRAIRIE RUN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-2665
Mailing Address - Country:US
Mailing Address - Phone:219-628-1292
Mailing Address - Fax:219-764-8256
Practice Address - Street 1:6846 PRAIRIE RUN AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-2665
Practice Address - Country:US
Practice Address - Phone:219-628-1292
Practice Address - Fax:219-764-8256
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28112325A163W00000X
MI4704232837163W00000X
IL163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WP0000XNursing Service ProvidersRegistered NursePain Management