Basic Information
| Provider Information | |||||||||
| NPI: | 1578732079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9000 N MAIN ST | ||||||||
| Address2: | SUITE 227 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454151180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378324773 | ||||||||
| FaxNumber: | 9378322986 | ||||||||
| Practice Location | |||||||||
| Address1: | 9000 N MAIN ST | ||||||||
| Address2: | SUITE 227 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454151180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378324773 | ||||||||
| FaxNumber: | 9378322986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2008 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35.127434 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 01060464A | IN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 0101248192 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.