Individual
ROBERT POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
964 N 5TH AVE STE C, ST CHARLES, IL 60174-1204
(630) 208-4215
Mailing address
239 VALLEY VIEW DR, ST CHARLES, IL 60175-4646
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
160.004470
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36-34784281
FEIN
IL
Enumeration date
06/20/2011
Last updated
06/20/2011
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