MEDICARE: DR. MARY MICHAELS POHLMANN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1558344853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY MICHAELS POHLMANN M.D.

Provider Business Mailing Address
First Line	:	405 S DEER LAKE DR E
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-5253
Country	:	US
Telephone Number	:	618-549-5077
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 S DEER LAKE DR E
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-5253
Country	:	US
Telephone Number	:	618-549-5077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. MARY MICHAELS POHLMANN M.D.” Practice Location

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