Provider Demographics
NPI:1023437274
Name:POHL, DAVID JONATHAN (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JONATHAN
Last Name:POHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 BUSCH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4541
Mailing Address - Country:US
Mailing Address - Phone:847-459-7860
Mailing Address - Fax:847-459-4228
Practice Address - Street 1:1540 LAKE LANSING RD STE 202
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3757
Practice Address - Country:US
Practice Address - Phone:517-913-3820
Practice Address - Fax:517-913-3821
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101020964207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty