Provider Demographics
NPI:1144886136
Name:POWERS, MARK ALLAN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:POWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 N WALNUT ST STE 302
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5652
Mailing Address - Country:US
Mailing Address - Phone:248-420-9272
Mailing Address - Fax:
Practice Address - Street 1:59 N WALNUT ST STE 302
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5652
Practice Address - Country:US
Practice Address - Phone:248-420-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health