Healthcare Provider Details

I. General information

NPI: 1295265890
Provider Name (Legal Business Name): NADINE N DAWOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W. NINE MILE ROAD
SOUTHFIELD MI
48075-4807
US

IV. Provider business mailing address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3485
  • Fax: 248-849-2052
Mailing address:
  • Phone: 248-849-3485
  • Fax: 248-849-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008239
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: