Provider Demographics
NPI:1033293360
Name:POWELL, DEBORAH ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELIZABETH
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 609
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-673-1142
Mailing Address - Fax:
Practice Address - Street 1:500 HARVARD ST SE
Practice Address - Street 2:LAB MED & PATHOLOGY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0363
Practice Address - Country:US
Practice Address - Phone:612-273-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45468207ZM0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1034882OtherPREFERRED ONE
MN11-00337OtherMEDICA CHOICE
ND10387Medicaid
MN171944OtherUCARE
MN216910000Medicaid
MN11-00014OtherMEDICA PRIMARY
SD7777470Medicaid
MNHP40528OtherHEALTH PARTNERS
MN11-00014OtherMEDICA PRIMARY