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NPI Code Detail

MEDICARE: JOHN FREDERICK DILWORTH L.L.P.

MEDICARE: JOHN FREDERICK DILWORTH L.L.P.
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
1103TC0700XClinical Psychologist6301005958MI

General Provider Information

NPI Number : 1558604017
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN FREDERICK DILWORTH L.L.P.
Provider Business Mailing Address
First Line : 313 S GULL LAKE DR
Second Line :
City : RICHLAND
State : MI
Zip : 49083-9383
Country : US
Telephone Number : 269-254-6700
Fax Number :
Provider Business Practice Location Address
First Line : 491 COLUMBIA AVE E
Second Line : SUITE 4
City : BATTLE CREEK
State : MI
Zip : 49014-5468
Country : US
Telephone Number : 269-962-9611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2013
Last Update Date : 04/03/2013

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