Healthcare Provider Details

I. General information

NPI: 1215622899
Provider Name (Legal Business Name): DYLON DAOUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22250 PROVIDENCE DR
SOUTHFIELD MI
48075-4825
US

IV. Provider business mailing address

22250 PROVIDENCE DR
SOUTHFIELD MI
48075-4825
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3281
  • Fax: 248-849-5449
Mailing address:
  • Phone: 248-849-3281
  • Fax: 248-849-5449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5151016096
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: