Basic Information
| Provider Information | |||||||||
| NPI: | 1073608618 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEARBORN OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25080 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137308880 | ||||||||
| FaxNumber: | 3137301167 | ||||||||
| Practice Location | |||||||||
| Address1: | 25080 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137308880 | ||||||||
| FaxNumber: | 3137301167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | MEYER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3137308880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | TM0495914 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.