Provider Demographics
NPI:1053415042
Name:POWERS, GUY EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:EDWARD
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:GUY
Other - Middle Name:EDWARD
Other - Last Name:PIENKOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 HALL AVE
Mailing Address - Street 2:SUITE A MARINETTE COUNTY HEALTH AND HUMAN SERVICES
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:715-732-7760
Mailing Address - Fax:715-732-7711
Practice Address - Street 1:2500 HALL AVE
Practice Address - Street 2:SUITE A MARINETTE COUNTY HEALTH AND HUMAN SERVICES
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143
Practice Address - Country:US
Practice Address - Phone:715-732-7760
Practice Address - Fax:715-732-7711
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI430590202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34097100Medicaid
WI43059020OtherLICENSE #
WIBP6716635OtherDEA
WIBP6716635OtherDEA
WI43059020OtherLICENSE #