Provider Demographics
NPI:1033392774
Name:POWELL, MICHELE DENISE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:DENISE
Last Name:POWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7781 N POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3309
Mailing Address - Country:US
Mailing Address - Phone:336-765-3430
Mailing Address - Fax:336-765-3429
Practice Address - Street 1:7781 N POINT BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3309
Practice Address - Country:US
Practice Address - Phone:336-765-3430
Practice Address - Fax:336-765-3429
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20000150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131Y7Medicaid
NC1033392774OtherNPI
NCH54677Medicare UPIN
NC2299266BMedicare PIN