Provider Demographics
NPI:1164694113
Name:DEAN, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7148 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0071
Mailing Address - Country:US
Mailing Address - Phone:248-792-1779
Mailing Address - Fax:
Practice Address - Street 1:4727 SAINT ANTOINE ST
Practice Address - Street 2:STE 304
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1461
Practice Address - Country:US
Practice Address - Phone:313-745-0499
Practice Address - Fax:313-833-8801
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBH26634488101207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301090814OtherLICENSE
MI1164694113Medicaid
MIP50820014Medicare PIN