Provider Demographics
NPI: | 1356312565 |
---|---|
Name: | POHL, KENNETH P (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KENNETH |
Middle Name: | P |
Last Name: | POHL |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1 PRESTIGE PL |
Mailing Address - Street 2: | SUITE 550 |
Mailing Address - City: | MIAMISBURG |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45342-3794 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 937-762-1305 |
Mailing Address - Fax: | 937-522-7513 |
Practice Address - Street 1: | 5692 FAR HILLS AVE |
Practice Address - Street 2: | SUITE 4 |
Practice Address - City: | DAYTON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45429-2239 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-433-2054 |
Practice Address - Fax: | 937-433-1069 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-01-27 |
Last Update Date: | 2021-01-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35-03-2228P | 207X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 000000008801 | Other | ANTHEM |
OH | 3129911 | Medicaid | |
OH | 0985140 | Other | UNITED HEALTHCARE |
OH | 0985140 | Other | UNITED HEALTHCARE |
OH | 000000008801 | Other | ANTHEM |
OH | 9182431 | Medicare PIN |