Provider Demographics
NPI:1528020492
Name:DUMONT, ALLEN DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DALE
Last Name:DUMONT
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 1:3880 PENBERTON AVE.
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-995-2374
Mailing Address - Fax:
Practice Address - Street 1:911 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3203
Practice Address - Country:US
Practice Address - Phone:734-769-1198
Practice Address - Fax:734-769-2075
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301027689208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF06422Medicare ID - Type Unspecified
MIF06422Medicare UPIN