Provider Demographics
NPI:1366467615
Name:DAHLSTEDT, DENNIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:DAHLSTEDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44344 DEQUINDRE RD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1042
Mailing Address - Country:US
Mailing Address - Phone:586-254-7955
Mailing Address - Fax:586-254-5355
Practice Address - Street 1:44344 DEQUINDRE RD
Practice Address - Street 2:SUITE 490
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1038
Practice Address - Country:US
Practice Address - Phone:586-254-7955
Practice Address - Fax:586-254-5355
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301040007207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1424107-10Medicaid
MIA78119Medicare UPIN
MI0631321Medicare ID - Type Unspecified