Healthcare Provider Details

I. General information

NPI: 1427151083
Provider Name (Legal Business Name): MATTHEW B DEWYS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S BOWER ST
GREENVILLE MI
48838-2614
US

IV. Provider business mailing address

2537 MOMENTUM PL
CHICAGO IL
60689-5325
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-4341
  • Fax:
Mailing address:
  • Phone: 616-975-1845
  • Fax: 616-285-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5101009537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: