Powell, Ian R

Powell, Ian R is an individual health care provider with primary practice located at 34700 Valley Rd , Oconomowoc WI 53066-4500. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Allopathic & Osteopathic Physicians / Addiction Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Addiction Medicine is his primary health care specialty. Powell, Ian R can be contacted via phone (262) 646-1391.

Contact Information

Primary practice address
34700 Valley Rd Oconomowoc WI 53066-4500
Phone: (262) 646-1391
Fax: (262) 646-1393
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 103TA0400X 39133 Wisconsin
Allopathic & Osteopathic Physicians / Addiction Medicine 207RA0401X 39133 Wisconsin
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 39133 Wisconsin

Profile Details

NPI number 1346212545
LBN Legal business name Powell, Ian R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 2nd, 2006
Last updated Oct 20th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346212545 NPPES
Wisconsin MEDICAID 32580600

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