Healthcare Provider Details

I. General information

NPI: 1043258122
Provider Name (Legal Business Name): EJAZ ALI DAWSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27209 LAHSER RD STE 222
SOUTHFIELD MI
48034-8403
US

IV. Provider business mailing address

11885 E 12 MILE RD STE 302B
WARREN MI
48093-3467
US

V. Phone/Fax

Practice location:
  • Phone: 248-799-0434
  • Fax: 248-799-0675
Mailing address:
  • Phone: 248-799-0434
  • Fax: 248-799-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301058036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: