Healthcare Provider Details

I. General information

NPI: 1659292241
Provider Name (Legal Business Name): KAMAL POOLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E WOODBURY DR STE 110
DAYTON OH
45415-2853
US

IV. Provider business mailing address

7943 MOUNT HOOD
HUBER HEIGHTS OH
45424-6930
US

V. Phone/Fax

Practice location:
  • Phone: 937-373-7848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: