Provider Demographics
NPI:1215586656
Name:POWELL, AUSTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 SANFORD AVE SW # 46334
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1342
Mailing Address - Country:US
Mailing Address - Phone:734-707-1052
Mailing Address - Fax:734-661-1887
Practice Address - Street 1:2500 PACKARD ST STE 104A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6827
Practice Address - Country:US
Practice Address - Phone:734-707-1052
Practice Address - Fax:734-661-1887
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009517207P00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine