Provider Demographics
NPI:1518942176
Name:POWELL, ARTHUR M (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:M
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28625 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 243
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1828
Mailing Address - Country:US
Mailing Address - Phone:248-358-2310
Mailing Address - Fax:248-352-0734
Practice Address - Street 1:28625 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 243
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1828
Practice Address - Country:US
Practice Address - Phone:248-358-2310
Practice Address - Fax:248-352-0734
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC44319OtherM'CARE
MI1518942176Medicaid
MI700F314390OtherBLUE SHIELD
MI0631032OtherBCBS INDIVIDUAL
MI700F314390OtherBLUE SHIELD
MI1518942176Medicaid