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Organization
MEDICINE MAN MEDICAL, PLLC
Active
Organization
MEDICINE MAN MEDICAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY RAY POWELL II MD (PARTNER)
(317) 691-1824
Entity
Organization
Contact information
Practice address
25130 SOUTHFIELD ROAD, SUITE #210, SOUTHFIELD, MI 48075
(317) 691-1824
Mailing address
25130 SOUTHFIELD RD STE 120, SOUTHFIELD, MI 48075-1900
(317) 691-1824
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
12/04/2018
Last updated
12/04/2018
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