Healthcare Provider Details

I. General information

NPI: 1811097322
Provider Name (Legal Business Name): MARIA POWELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 ALGONQUIN RD SUITE 100
ROLLING MEADOWS IL
60008-3257
US

IV. Provider business mailing address

PO BOX 369
NEW LENOX IL
60451-0369
US

V. Phone/Fax

Practice location:
  • Phone: 847-788-0700
  • Fax: 847-788-0703
Mailing address:
  • Phone: 815-463-0098
  • Fax: 815-462-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036063687
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: