Provider Demographics
NPI:1134122245
Name:DANGOVIAN, MICHAEL I (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:DANGOVIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:39242 DEQUINDRE RD
Mailing Address - Street 2:SUITE103
Mailing Address - City:STERLING HGTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310
Mailing Address - Country:US
Mailing Address - Phone:586-795-3600
Mailing Address - Fax:248-795-5446
Practice Address - Street 1:39242 DEQUINDRE RD
Practice Address - Street 2:SUITE103
Practice Address - City:STERLING HGTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-795-3600
Practice Address - Fax:586-795-5446
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2009-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIMD008866207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3324361Medicaid
MIF04789Medicare UPIN