Polack, Donovan C

Polack, Donovan C is an individual health care provider with primary practice located at 1265 Graham Rd Ste 1 , Florissant MO 63031-8018. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Nephrology. Allopathic & Osteopathic Physicians / Nephrology is his primary health care specialty. Polack, Donovan C can be contacted via phone (314) 741-1600.

Contact Information

Primary practice address
1265 Graham Rd Ste 1 Florissant MO 63031-8018
Phone: (314) 741-1600
Fax: (314) 741-1677
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 036-072078 Illinois
Other Service Providers / Specialist 174400000X R5H69 Missouri
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 036-072078 Illinois
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X R5H69 Missouri

Profile Details

NPI number 1659324465
LBN Legal business name Polack, Donovan C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2006
Last updated May 22nd, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1659324465 NPPES
Illinois MEDICAID 036072078
Illinois MEDICAID 202546321

Popular Providers