Provider Demographics
NPI:1558310771
Name:SPRINGER, DAWN ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ELLEN
Last Name:SPRINGER
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 1:230 TEMPLE ST
Mailing Address - Street 2:PO BOX 39
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1837
Mailing Address - Country:US
Mailing Address - Phone:517-676-9066
Mailing Address - Fax:517-676-3505
Practice Address - Street 1:230 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1837
Practice Address - Country:US
Practice Address - Phone:517-676-9066
Practice Address - Fax:517-676-3505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039046207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4452569OtherAETNA
MIP58971OtherBCN
MI0170081OtherPHPFC
MIDS039046OtherBCBS
MI0100041OtherPHPMM
MI3202019Medicaid
MI0100041OtherPHPMM
MI4452569OtherAETNA