Healthcare Provider Details

I. General information

NPI: 1295778694
Provider Name (Legal Business Name): STEVEN BRIAN POWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY MURDOCK 622
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

1653 W CONGRESS PKWY MURDOCK 622
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6640
  • Fax: 312-942-4370
Mailing address:
  • Phone: 312-942-6640
  • Fax: 312-942-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036111991
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: