Healthcare Provider Details

I. General information

NPI: 1396027892
Provider Name (Legal Business Name): GERALD M. POHOST, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TER SUITE 150
GLENDALE CA
91206-4071
US

IV. Provider business mailing address

2200 N MAYFAIR RD SUITE 200
WAUWATOSA WI
53226-2252
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-3501
  • Fax: 818-956-7680
Mailing address:
  • Phone: 414-258-9511
  • Fax: 414-607-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. GERALD M. POHOST
Title or Position: OWNER
Credential: MD
Phone: 818-409-3501