Healthcare Provider Details

I. General information

NPI: 1609966696
Provider Name (Legal Business Name): NORTH WOODWARD INTERNAL MEDICINE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W 14 MILE RD SUITE 100
CLAWSON MI
48017-3100
US

IV. Provider business mailing address

555 W 14 MILE RD SUITE 100
CLAWSON MI
48017-3100
US

V. Phone/Fax

Practice location:
  • Phone: 248-655-1400
  • Fax: 248-655-2646
Mailing address:
  • Phone: 248-655-1400
  • Fax: 248-655-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN ANDERSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-655-2641