Healthcare Provider Details

I. General information

NPI: 1871534636
Provider Name (Legal Business Name): GERALD M. POHOST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TERRACE SUITE 150
GLENDALE CA
61206-4007
US

IV. Provider business mailing address

2200 NORTH MAYFAIR ROAD 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 Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG86422
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberG84622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: