Individual
MR. PAVEL POLINOVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
675 N ST CLAIR ST, STE 20-100 GALTER PAVILION, CHICAGO, IL 60611
(312) 695-1920
(312) 695-5747
Mailing address
675 N ST CLAIR ST, STE 20-100 GALTER PAVILION, CHICAGO, IL 60611-8709
(312) 695-1920
(312) 695-5747
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004046
IL
363AS0400X
Surgical Physician Assistant
085004046
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
F400187717
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
06/27/2011
Last updated
08/27/2025
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