Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 5101020446 | MI |
NPI | 1134460439 |
---|---|
Provider Name | Dr. Adam L Powell |
First Address | Grand Rapids, MI 49512-2091 |
Second Address | Grand Rapids, MI 49546-6113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2013 |
Last Update Date | 13/05/2021 |