MEDICARE: DR. DAVID WAYNE POWELL AU.D.

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	231H00000X	Audiologist	147000948	IL

General Provider Information

NPI Number	:	1386697597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WAYNE POWELL AU.D.

Provider Business Mailing Address
First Line	:	12236 SLEEPY HOLLOW RD
Second Line	:
City	:	ROSCOE
State	:	IL
Zip	:	61073-9098
Country	:	US
Telephone Number	:	773-339-4791
Fax Number	:

Provider Business Practice Location Address
First Line	:	6653 WEAVER RD STE 116
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-8068
Country	:	US
Telephone Number	:	815-315-7152
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/05/2023

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