Healthcare Provider Details

I. General information

NPI: 1679583504
Provider Name (Legal Business Name): DOLLY BONDARIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD STE 208
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

2723 S STATE ST STE 150
ANN ARBOR MI
48104-6188
US

V. Phone/Fax

Practice location:
  • Phone: 313-271-5565
  • Fax: 313-271-1053
Mailing address:
  • Phone: 734-316-7880
  • Fax: 888-837-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301050670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: