Provider Demographics
NPI:1518749910
Name:DORSEY, MICHAEL JR (CHW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DORSEY
Suffix:JR
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9961 ROBSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-2416
Mailing Address - Country:US
Mailing Address - Phone:248-242-2766
Mailing Address - Fax:
Practice Address - Street 1:12411 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2154
Practice Address - Country:US
Practice Address - Phone:248-272-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker