Provider Demographics
NPI:1942357959
Name:DEAN CLINIC, P.C.
Entity Type:Organization
Organization Name:DEAN CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-366-9502
Mailing Address - Street 1:4140 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1014
Mailing Address - Country:US
Mailing Address - Phone:313-366-9502
Mailing Address - Fax:313-366-9503
Practice Address - Street 1:4140 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1014
Practice Address - Country:US
Practice Address - Phone:313-366-9502
Practice Address - Fax:313-366-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1371362Medicaid
MI1371362Medicaid
MI5500052Medicare ID - Type Unspecified