Healthcare Provider Details

I. General information

NPI: 1558644476
Provider Name (Legal Business Name): D J DAWSON MD INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 03/26/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9610H N CENTENNIAL DR STE H
MUNSTER IN
46321-4077
US

IV. Provider business mailing address

536 W 55TH AVE
MERRILLVILLE IN
46410-2010
US

V. Phone/Fax

Practice location:
  • Phone: 219-249-0098
  • Fax:
Mailing address:
  • Phone: 773-677-9676
  • Fax: 219-888-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEREK J DAWSON
Title or Position: OWNER
Credential: MD
Phone: 773-677-9676