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Organization

MEDICINE MAN MEDICAL, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JERRY RAY POWELL II MD (PARTNER)
(317) 691-1824
Entity
Organization

Contact information

Practice address
25130 SOUTHFIELD ROAD, SUITE #210, SOUTHFIELD, MI 48075
(317) 691-1824
Mailing address
25130 SOUTHFIELD RD STE 120, SOUTHFIELD, MI 48075-1900
(317) 691-1824

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary

Other

Enumeration date
12/04/2018
Last updated
12/04/2018
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