Healthcare Provider Details

I. General information

NPI: 1003500125
Provider Name (Legal Business Name): ANDREW POWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 200
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

133 BENMORE DR
WINTER PARK FL
32792-4111
US

V. Phone/Fax

Practice location:
  • Phone: 746-646-7469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number178485
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number37626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: