Provider Demographics
NPI:1295778694
Name:POWELL, STEVEN BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BRIAN
Last Name:POWELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:MURDOCK 622
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-6640
Mailing Address - Fax:312-942-4370
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:MURDOCK 622
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-6640
Practice Address - Fax:312-942-4370
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-11-26
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361119912080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-111991Medicaid
ILH02026Medicare UPIN