MEDICARE: DR. RICHARD JOSEPH POWERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036.037310	IL

General Provider Information

NPI Number	:	1396115622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JOSEPH POWERS M.D.

Provider Business Mailing Address
First Line	:	1015 S ALDINE AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-4478
Country	:	US
Telephone Number	:	847-692-5126
Fax Number	:	847-692-6853

Provider Business Practice Location Address
First Line	:	1015 S ALDINE AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-4478
Country	:	US
Telephone Number	:	847-692-5126
Fax Number	:	847-692-6853

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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