Provider Demographics
NPI:1558344853
Name:POHLMANN, MARY MICHAELS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MICHAELS
Last Name:POHLMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S DEER LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5253
Mailing Address - Country:US
Mailing Address - Phone:618-549-5077
Mailing Address - Fax:
Practice Address - Street 1:405 S DEER LAKE DR E
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5253
Practice Address - Country:US
Practice Address - Phone:618-549-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine