Basic Information
| Provider Information | |||||||||
| NPI: | 1619094208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAHL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ANTON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2760 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908062755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624246666 | ||||||||
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| Practice Location | |||||||||
| Address1: | 335 W SPRING ST | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385013125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313727716 | ||||||||
| FaxNumber: | 9313720087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MT187070 | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.