Provider Demographics
NPI:1558317990
Name:SEVERSON, DAWN M (MD)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:MATHENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43630 HAYES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3536
Mailing Address - Country:US
Mailing Address - Phone:586-323-4530
Mailing Address - Fax:
Practice Address - Street 1:43630 HAYES RD STE 200
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3536
Practice Address - Country:US
Practice Address - Phone:586-323-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077911207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN65730036Medicare PIN