Individual
DR. IAN R POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-1391
(262) 646-1393
Mailing address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
39133
WI
207R00000X
Internal Medicine Physician
39133
WI
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
39133
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32580600
—
WI
Enumeration date
02/02/2006
Last updated
10/20/2012
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