Healthcare Provider Details

I. General information

NPI: 1174524979
Provider Name (Legal Business Name): MICHAEL L POOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 KIMEL PARK DR SUITE 100
WINSTON SALEM NC
27103-6951
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-277-1800
  • Fax: 336-277-6981
Mailing address:
  • Phone: 336-277-1800
  • Fax: 336-277-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD12654
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: