Individual
POLLY LOVE MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
28473
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0818315
MEDICA CHOICE
MN
01
—
180009769
RAILROAD MEDICARE
MN
01
—
54817MC
BCBS OF MN
MN
05
—
967888300
—
MN
Enumeration date
06/27/2005
Last updated
04/23/2013
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