Provider Demographics
NPI:1467474643
Name:POWERS, MICHAEL RAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:POWERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10782 V ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2952
Mailing Address - Country:US
Mailing Address - Phone:402-504-9747
Mailing Address - Fax:402-991-6766
Practice Address - Street 1:10782 V ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-2952
Practice Address - Country:US
Practice Address - Phone:402-504-9747
Practice Address - Fax:402-991-6766
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE276213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025518100Medicaid
NE10025640100Medicaid
NE1427348838OtherGROUP NPI NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC
NE10025518200Medicaid
NE10025518000Medicaid
NEU80942Medicare UPIN
NE278196Medicare ID - Type Unspecified
NENA1914Medicare PIN
NE10025518100Medicaid
NE10025518000Medicaid
NENA1914001Medicare PIN