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General NPI Number Information
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NPI Number | 1548262702
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Entity Type | Individual
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Provider Name | MARILYNN S. DEWALD M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1000 CEDAR ST
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City | HOUGHTON
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State | MI
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Zip | 49931-1978
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Country | US
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Telephone | 906-487-1710
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Fax | 906-487-9421
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Provider Business Mailing Address
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Address Line | 1000 CEDAR ST
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City | HOUGHTON
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State | MI
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Zip | 49931-1978
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Country | US
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Telephone | 906-487-1710
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Fax | 906-487-9421
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301056759
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License Number State | MI
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