Provider Demographics
NPI:1760795835
Name:POH
Entity Type:Organization
Organization Name:POH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGERY RESIDENT/INTERN
Authorized Official - Prefix:
Authorized Official - First Name:LEITH
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-590-7375
Mailing Address - Street 1:2695 BEACON HILL DR APT 306
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3752
Mailing Address - Country:US
Mailing Address - Phone:816-590-7375
Mailing Address - Fax:
Practice Address - Street 1:2695 BEACON HILL DR APT 306
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3752
Practice Address - Country:US
Practice Address - Phone:816-590-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315045279282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital