Provider Demographics
NPI:1265449854
Name:HERNANDEZ, DAWN-ALITA ROBERTS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN-ALITA
Middle Name:ROBERTS
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 YPSILANTI ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-1144
Mailing Address - Country:US
Mailing Address - Phone:734-545-2100
Mailing Address - Fax:866-458-7520
Practice Address - Street 1:1234 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2112
Practice Address - Country:US
Practice Address - Phone:269-983-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN71771207RC0200X
AZ67436207RP1001X
OH35085662207RP1001X
MI4301112866207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2593288Medicaid
OH2593288Medicaid
I32647Medicare UPIN
OHHE4161685Medicare ID - Type Unspecified