MEDICARE: MR. LARRY DAWKINS II CCHW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	142899727	MI

General Provider Information

NPI Number	:	1164370847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY DAWKINS II CCHW

Provider Business Mailing Address
First Line	:	1470 PARIS AVE APT 12
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1668
Country	:	US
Telephone Number	:	313-221-4885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1470 PARIS AVE APT 12
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1668
Country	:	US
Telephone Number	:	313-221-4885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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