=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467585729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L JEAN DUNEGAN M.D. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9912 E GRAND RIVER AVE STE 1000
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48116-1973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-623-8182
-----------------------------------------------------
Fax | 810-225-0790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5065 MORET CT
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48116-4788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-623-8182
-----------------------------------------------------
Fax | 810-225-0790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LOIS JEAN DUNEGAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 810-623-8182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4301037571
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------