Provider Demographics
NPI:1104917137
Name:POLLACK, ANIA G (MD)
Entity type:Individual
Prefix:
First Name:ANIA
Middle Name:G
Last Name:POLLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:G
Other - Last Name:POLLACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:STE 5254A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-4200
Mailing Address - Fax:937-208-4205
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:STE 5254A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-4200
Practice Address - Fax:937-208-4205
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31441207T00000X
OH35.122856207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS927663OtherFIRSTGUARD
MO35914019OtherBCBS KANSAS CITY
MO207530403Medicaid
KS200335380AMedicaid
MO35914019OtherBCBS KANSAS CITY
MO207530403Medicaid
KS927663OtherFIRSTGUARD
OHH275820Medicare PIN