1356312565 NPI number — DR. KENNETH P POHL M.D.

Table of content: DR. KENNETH P POHL M.D. (NPI 1356312565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356312565 NPI number — DR. KENNETH P POHL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POHL
Provider First Name:
KENNETH
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356312565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PRESTIGE PL
Provider Second Line Business Mailing Address:
SUITE 550
Provider Business Mailing Address City Name:
MIAMISBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45342-3794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-762-1305
Provider Business Mailing Address Fax Number:
937-522-7513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5692 FAR HILLS AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45429-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-433-2054
Provider Business Practice Location Address Fax Number:
937-433-1069
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  35-03-2228P , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000008801 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3129911 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0985140 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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