Healthcare Provider Details

I. General information

NPI: 1881617322
Provider Name (Legal Business Name): WILLIAM JOHN POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24500 NORTHWESTERN HWY
SOUTHFIELD MI
48075
US

IV. Provider business mailing address

3901 BEAUBIEN ST DEPT OF
DETROIT MI
48201-2119
US

V. Phone/Fax

Practice location:
  • Phone: 248-353-1280
  • Fax: 248-353-6193
Mailing address:
  • Phone: 313-745-0255
  • Fax: 313-993-0393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301070195
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number4301070195
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301070195
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: