Healthcare Provider Details

I. General information

NPI: 1225569767
Provider Name (Legal Business Name): MICHAEL DZIEWIT JR. D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 12/15/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 E JOLLY RD
LANSING MI
48910-8547
US

IV. Provider business mailing address

3390 E JOLLY RD
LANSING MI
48910-8547
US

V. Phone/Fax

Practice location:
  • Phone: 561-882-8673
  • Fax: 517-882-3935
Mailing address:
  • Phone: 517-882-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901400358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: