Healthcare Provider Details

I. General information

NPI: 1558570580
Provider Name (Legal Business Name): KAREN LYNNE POWERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 STONEGATE PARK SUITE 300
SAINT JOSEPH MI
49085-9137
US

IV. Provider business mailing address

3901 STONEGATE PARK SUITE 300
SAINT JOSEPH MI
49085-9137
US

V. Phone/Fax

Practice location:
  • Phone: 269-556-6000
  • Fax:
Mailing address:
  • Phone: 269-556-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number7665984-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301108662
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: