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General NPI Number Information
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NPI Number | 1326245663
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC RECONSTRUCTIVE SURGERY, INC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 5692 FAR HILLS AVE SUITE 4
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City | DAYTON
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State | OH
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Zip | 45429-2239
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Country | US
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Telephone | 937-433-2054
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Fax | 937-433-1069
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Provider Business Mailing Address
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Address Line | 5692 FAR HILLS AVE SUITE 4
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City | DAYTON
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State | OH
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Zip | 45429-2239
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Country | US
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Telephone | 937-433-2054
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Fax | 937-433-1069
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH P POHL
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Credential | M.D.
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Telephone | 937-433-2054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35032228P
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License Number State | OH
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