MEDICARE: JACQUELINE POWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	81524	WI

General Provider Information

NPI Number	:	1093276990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE POWELL MD

Provider Business Mailing Address
First Line	:	7974 UW HEALTH CT
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	UW HOSPITALS & CLINICS 600 HIGHLAND AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53792-3098
Country	:	US
Telephone Number	:	608-263-6240
Fax Number	:	608-265-1726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	02/05/2024

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