MEDICARE: DR. EDGAR ALLAN POU 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
1	208D00000X	General Practice Physician	4301087010	MI

General Provider Information

NPI Number	:	1588794523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGAR ALLAN POU M,D.

Provider Business Mailing Address
First Line	:	1985 GRATIOT AVE
Second Line	:	STE 2A
City	:	MARYSVILLE
State	:	MI
Zip	:	48040-1200
Country	:	US
Telephone Number	:	810-364-5050
Fax Number	:	810-364-5688

Provider Business Practice Location Address
First Line	:	1985 GRATIOT BLVD STE 2A
Second Line	:
City	:	MARYSVILLE
State	:	MI
Zip	:	48040-2215
Country	:	US
Telephone Number	:	810-364-5050
Fax Number	:	810-364-5688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	02/15/2021

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