MEDICARE: DR. HELENE CLAIRE DOMBROWSKI M.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	207NS0135X	Procedural Dermatology Physician	4301406059	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCBSM	OTHER	MI	0708251301

General Provider Information

NPI Number	:	1659351948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HELENE CLAIRE DOMBROWSKI M.D.

Provider Business Mailing Address
First Line	:	23100 CHERRY HILL ST
Second Line	:	SUITE #10
City	:	DEARBORN
State	:	MI
Zip	:	48124-1493
Country	:	US
Telephone Number	:	313-563-6655
Fax Number	:	313-563-5517

Provider Business Practice Location Address
First Line	:	23100 CHERRY HILL ST
Second Line	:	SUITE #10
City	:	DEARBORN
State	:	MI
Zip	:	48124-1493
Country	:	US
Telephone Number	:	313-563-6655
Fax Number	:	313-563-5517

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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