Individual
DR. DONOVAN C POLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1265 GRAHAM RD STE 1, FLORISSANT, MO 63031-8018
(314) 741-1600
(314) 741-1677
Mailing address
1265 GRAHAM RD STE 1, FLORISSANT, MO 63031-8018
(314) 741-1600
(314) 741-1677
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036-072078
IL
174400000X
Specialist
R5H69
MO
207RN0300X
Nephrology Physician
036-072078
IL
207RN0300X
Nephrology Physician
Primary
R5H69
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072078
—
IL
05
—
202546321
—
MO
Enumeration date
05/19/2006
Last updated
05/22/2024
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