Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | A05946 | IA |
NPI | 1225000813 |
---|---|
Provider Name | Michael K Powell |
First Address | Cedar Rapids, IA 52402-7488 |
Second Address | Cedar Rapids, IA 52402-7488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 04/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
57354 | BLUE CROSS BLUE SHIELD (01) | IA |