Individual
KEISHA LESHON POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
319 E MADISON ST FL 3, SPRINGFIELD, IL 62701
(217) 545-8000
(217) 545-2275
Mailing address
PO BOX 19642, SPRINGFIELD, IL 62794-9642
(217) 545-8000
(217) 545-2275
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036.140456
IL
2084P0804X
Child & Adolescent Psychiatry Physician
036-140456
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-140456
STATE LICENSE
IL
Enumeration date
06/21/2013
Last updated
06/09/2018
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