Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Donovan C Polack, MD

Individual provider Specialist · NPI 1659324465

Dr. Donovan C Polack, MD is an Internal Medicine in Florissant, Missouri. Graduated from Js Weill Medical College, Cornell University in 1979, 47 years ago. Practices with St Louis Kidney Care LLC, an 8-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Illinois and Missouri.

Years since qualifying
47
Trained at
Js Weill Medical College, Cornell University
Licensed in
IL, MO
In the registry since
2006
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1265 Graham Rd Ste 1
Florissant, MO 63031-8018
Phone: (314) 741-1600
Fax: (314) 741-1677
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2044 Madison Ave Ste 15, Granite City, IL 62040-4641 — (314) 741-1600

Specialties & licences

Nephrology Physician (primary) Taxonomy 207RN0300X · Licence R5H69 (MO)
Specialist Taxonomy 174400000X · Licence 036-072078 (IL)
Specialist Taxonomy 174400000X · Licence R5H69 (MO)
Nephrology Physician Taxonomy 207RN0300X · Licence 036-072078 (IL)

Record details

NPI number1659324465
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 19, 2006
Last updated in NPPESMay 22, 2024
Certification dateMay 22, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Also practisesNEPHROLOGY
Medical schoolJS WEILL MEDICAL COLLEGE, CORNELL UNIVERSITY
Graduated 1979 (47 years in practice)
Group practice St Louis Kidney Care Llc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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