Healthcare Provider Details

I. General information

NPI: 1831481696
Provider Name (Legal Business Name): MR. KEVIN MICHAEL POWERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEVIN MICHAEL POWERS OPAC

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 SUNSET AVE
UTICA NY
13502-5617
US

IV. Provider business mailing address

1903 SUNSET AVE
UTICA NY
13502-5617
US

V. Phone/Fax

Practice location:
  • Phone: 315-735-4496
  • Fax:
Mailing address:
  • Phone: 315-735-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number000184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: