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Contact Information

IAN R POWELL, MD
34700 VALLEY RD
OCONOMOWOC, WI53066-4500
 Phone: 262-646-1391
 Fax: 262-646-1393
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction Medicine

207RA0401X 11 Physician/Internal Medicine
 

Addiction (Substance Use Disorder)

103TA0400X 62 Psychologist, Clinical
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for IAN R POWELL · (Male)

NPI # 1346212545
Status Active
Credentials MD
Entity Individual
Enumeration date 02/02/2006
Last updated 10/20/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 39133
  • WI Medicaid 32580600
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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