Healthcare Provider Details

I. General information

NPI: 1316391253
Provider Name (Legal Business Name): SCOTT JOSEPH DAWSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST
DETROIT MI
48201-1916
US

IV. Provider business mailing address

10201 CARNEGIE AVE
CLEVELAND OH
44106-2130
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-1000
  • Fax: 313-576-1239
Mailing address:
  • Phone: 216-938-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.14076
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number4301507483
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35.14076
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number4301507483
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: