Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301068103 | MI |
NPI | 1003914854 |
---|---|
Provider Name | Dawn D Dewitt |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Zeeland, MI 49464-2609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 02/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H20006 | (02) | MI |