Healthcare Provider Details

I. General information

NPI: 1164511036
Provider Name (Legal Business Name): RODNEY L DEWYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 PROFESSIONAL CENTRE DR. SUITE 120
HAMBURG MI
48139
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR LBBY J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 810-231-0252
  • Fax: 810-231-0256
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301065486
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: