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
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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:
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Provider Licenses
StateLicense IDTaxonomies
OH35-03-2228P207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000008801OtherANTHEM
OH3129911Medicaid
OH0985140OtherUNITED HEALTHCARE
OH0985140OtherUNITED HEALTHCARE
OH000000008801OtherANTHEM
OH9182431Medicare PIN