Provider Demographics
NPI:1487954616
Name:POEHLS, JAMES MICHAEL
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:POEHLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 GLOUCESTER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1855
Mailing Address - Country:US
Mailing Address - Phone:715-864-3939
Mailing Address - Fax:
Practice Address - Street 1:N6654 ROLLING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-9471
Practice Address - Country:US
Practice Address - Phone:920-906-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator