Individual
DR. MARIO R POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 PORT WASHINGTON RD, DIVISION OF NEONATOLOGY, GRAFTON, WI 53024-9201
(262) 329-1000
Mailing address
975 PORT WASHINGTON RD, DIVISION OF NEONATOLOGY, GRAFTON, WI 53024-9201
(262) 329-1000
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
46494
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008906261V
HUMANA
—
05
—
1609828391
—
WI
Enumeration date
05/17/2006
Last updated
09/17/2019
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