Provider Demographics
NPI:1003812926
Name:DISCH, DENNIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:DISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:61 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2207
Mailing Address - Country:US
Mailing Address - Phone:269-684-6777
Mailing Address - Fax:269-683-5384
Practice Address - Street 1:61 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2207
Practice Address - Country:US
Practice Address - Phone:269-684-6777
Practice Address - Fax:269-683-5384
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2018-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO104853207RC0000X
MI4301115814207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208700203Medicaid
MO208700203Medicaid
MO208700203Medicaid
MO208700203Medicaid