Healthcare Provider Details

I. General information

NPI: 1649497850
Provider Name (Legal Business Name): LINDSAY ROSE DUNSTAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY ROSE DYKEMA MD

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44725 GRAND RIVER AVE STE 104
NOVI MI
48375-1024
US

IV. Provider business mailing address

2255 ATKINSON ST
DETROIT MI
48206-2010
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3633
Mailing address:
  • Phone: 646-483-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301097316
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: