# MEDICINE MAN MEDICAL, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811467657
- **Authorized official:** DR. JERRY RAY POWELL II MD (PARTNER)
- **Authorized official phone:** (317) 691-1824

## Contact information

- **Practice address:** 25130 SOUTHFIELD ROAD, SUITE \#210, SOUTHFIELD, MI 48075
- **Practice address phone:** (317) 691-1824
- **Mailing address:** 25130 SOUTHFIELD RD STE 120, SOUTHFIELD, MI 48075-1900
- **Mailing address phone:** (317) 691-1824

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/04/2018
- **Last updated:** 12/04/2018