MEDICARE: DR. MICHAEL T DIMENT 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
1	207X00000X	Orthopaedic Surgery Physician	4301060984	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	382372161	OTHER	MI	TAX ID #
2	0466751	OTHER	MI	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932168291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL T DIMENT MD

Provider Business Mailing Address
First Line	:	770 RIVERSIDE AVE
Second Line	:	SUITE 105
City	:	ADRIAN
State	:	MI
Zip	:	49221-1446
Country	:	US
Telephone Number	:	517-265-0600
Fax Number	:	517-265-1535

Provider Business Practice Location Address
First Line	:	770 RIVERSIDE AVE
Second Line	:	SUITE 105
City	:	ADRIAN
State	:	MI
Zip	:	49221-1476
Country	:	US
Telephone Number	:	517-265-5230
Fax Number	:	517-265-1535

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/03/2023

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