Provider Demographics
NPI:1750310264
Name:POWERS, RICHARD J (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
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 1:434 E PALATINE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-5119
Mailing Address - Country:US
Mailing Address - Phone:847-398-0900
Mailing Address - Fax:847-398-0973
Practice Address - Street 1:434 E PALATINE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-5119
Practice Address - Country:US
Practice Address - Phone:847-398-0900
Practice Address - Fax:847-398-0973
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003935213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T36967Medicare UPIN
760890Medicare ID - Type Unspecified