Provider Demographics
NPI:1477538494
Name:DAWSON, PHILIP L (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1638
Mailing Address - Country:US
Mailing Address - Phone:269-381-3521
Mailing Address - Fax:269-381-4703
Practice Address - Street 1:1535 GULL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1638
Practice Address - Country:US
Practice Address - Phone:269-381-3521
Practice Address - Fax:269-381-4703
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301050289207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3218298Medicaid
MI5180458Medicaid
MI5180458Medicaid