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NPI Code Detail

MEDICARE: DR. ANTJE SOUTHWICK DEW MD

MEDICARE: DR. ANTJE SOUTHWICK DEW MD
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
1208000000XPediatrics Physician4301078492MI

General Provider Information

NPI Number : 1700855475
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTJE SOUTHWICK DEW MD
Provider Business Mailing Address
First Line : 1900 TIMBER RIDGE DR SE
Second Line :
City : ADA
State : MI
Zip : 49301-9359
Country : US
Telephone Number : 616-682-2045
Fax Number :
Provider Business Practice Location Address
First Line : 3152 PORT SHELDON ST
Second Line : SUITE C
City : HUDSONVILLE
State : MI
Zip : 49426-9297
Country : US
Telephone Number : 616-669-9238
Fax Number : 616-669-8296
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2006
Last Update Date : 07/08/2007

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