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NPI Code Detail

MEDICARE: MICHAEL J POLE M.D.

MEDICARE: MICHAEL J POLE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician35.068270OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00358054OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2000000491789OTHEROHANTHEM BCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154390292
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL J POLE M.D.
Provider Business Mailing Address
First Line : PO BOX 5500
Second Line :
City : LONGVIEW
State : TX
Zip : 75608-5500
Country : US
Telephone Number : 903-663-4800
Fax Number : 419-223-2726
Provider Business Practice Location Address
First Line : 725 S SHOOP AVE
Second Line :
City : WAUSEON
State : OH
Zip : 43567-1702
Country : US
Telephone Number : 419-335-2015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 04/15/2025

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