Healthcare Provider Details

I. General information

NPI: 1497104442
Provider Name (Legal Business Name): MICHAEL LEE POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 S 69TH ST STE 101
LINCOLN NE
68516-3892
US

IV. Provider business mailing address

7100 S 69TH ST STE 101
LINCOLN NE
68516-3892
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-7100
  • Fax: 402-489-3249
Mailing address:
  • Phone: 402-489-7100
  • Fax: 402-489-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30882
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: