MEDICARE: DAWN VERGIN R.D.

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	133V00000X	Registered Dietitian	886904

General Provider Information

NPI Number	:	1396288288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN VERGIN R.D.

Provider Business Mailing Address
First Line	:	22151 MOROSS RD STE 135
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48236-2165
Country	:	US
Telephone Number	:	313-343-7047
Fax Number	:

Provider Business Practice Location Address
First Line	:	22151 MOROSS RD STE 135
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48236-2165
Country	:	US
Telephone Number	:	313-343-7047
Fax Number	:

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

Provider Enumeration Date	:	11/23/2016
Last Update Date	:	11/23/2016

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Directions to “ DAWN VERGIN R.D.” Practice Location

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