Provider Demographics
NPI:1881694933
Name:POLLACK, JOHN S (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:POLLACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11516 183RD PL STE SW
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9471
Mailing Address - Country:US
Mailing Address - Phone:708-877-1300
Mailing Address - Fax:708-596-8719
Practice Address - Street 1:300 BARNEY DR STE D
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5279
Practice Address - Country:US
Practice Address - Phone:815-744-7515
Practice Address - Fax:815-744-7661
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2022-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036096324207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096324Medicaid
IL180031254OtherRRMC
IL036096324Medicaid
IL180031254OtherRRMC