Provider Demographics
NPI:1609856871
Name:DOBZYNIAK, ALLAN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:EDWARD
Last Name:DOBZYNIAK
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 1:17000 HUBBARD DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4258
Mailing Address - Country:US
Mailing Address - Phone:313-271-3802
Mailing Address - Fax:
Practice Address - Street 1:17000 HUBBARD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4258
Practice Address - Country:US
Practice Address - Phone:313-271-3802
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAD029491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI98999OtherPPOM PAYOR ID
MI1108262921OtherBLUE CROSS ID#
MIC1802OtherMCARE
MI1099661Medicaid
MIB45474Medicare UPIN
MI0826292Medicare ID - Type Unspecified