Provider Demographics
NPI:1821233321
Name:POLLAK, DEBORAH EVE (MD)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:EVE
Last Name:POLLAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:POLLAK
Other - Last Name:BOUGHTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:152 BANK ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1033
Mailing Address - Country:US
Mailing Address - Phone:612-339-1248
Mailing Address - Fax:
Practice Address - Street 1:152 BANK ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1033
Practice Address - Country:US
Practice Address - Phone:612-339-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0274382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry