Healthcare Provider Details

I. General information

NPI: 1053415042
Provider Name (Legal Business Name): GUY EDWARD POWERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. GUY EDWARD PIENKOS

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HALL AVE SUITE A MARINETTE COUNTY HEALTH AND HUMAN SERVICES
MARINETTE WI
54143
US

IV. Provider business mailing address

2500 HALL AVE SUITE A MARINETTE COUNTY HEALTH AND HUMAN SERVICES
MARINETTE WI
54143
US

V. Phone/Fax

Practice location:
  • Phone: 715-732-7760
  • Fax: 715-732-7711
Mailing address:
  • Phone: 715-732-7760
  • Fax: 715-732-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number43059020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: