Provider Demographics
NPI:1750352068
Name:POWELL, MICHELLE C (DO MPA)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:C
Last Name:POWELL
Suffix:
Gender:F
Credentials:DO MPA
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:C
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO MPH
Mailing Address - Street 1:17100 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3102
Mailing Address - Country:US
Mailing Address - Phone:305-948-4701
Mailing Address - Fax:305-948-8591
Practice Address - Street 1:17100 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3102
Practice Address - Country:US
Practice Address - Phone:305-948-4701
Practice Address - Fax:305-948-8591
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLXLOS0007263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260008100Medicaid
FL44542UMedicare ID - Type UnspecifiedNEW LOCATION
G89443Medicare UPIN
FL44542VMedicare ID - Type Unspecified
FL260008100Medicaid