Provider Demographics
NPI:1851572549
Name:MITCHELL POLLAK MD PA
Entity Type:Organization
Organization Name:MITCHELL POLLAK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:POLLAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-345-6789
Mailing Address - Street 1:8100 ROYAL PALM BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5733
Mailing Address - Country:US
Mailing Address - Phone:954-345-6789
Mailing Address - Fax:954-345-7998
Practice Address - Street 1:8100 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5733
Practice Address - Country:US
Practice Address - Phone:954-345-6789
Practice Address - Fax:954-345-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00050840261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicare PIN
FL0239430001Medicare NSC