Individual
CARSON POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE # 60153, MAYWOOD, IL 60153-3328
(788) 488-8584
Mailing address
729 E NORTHSHORE DR, SYRACUSE, IN 46567-2140
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125.082700
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
04/03/2023
Last updated
06/16/2023
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