Provider Demographics
NPI:1487526885
Name:DUNWOODY, FLORENTHIA LAVON
Entity type:Individual
Prefix:MRS
First Name:FLORENTHIA
Middle Name:LAVON
Last Name:DUNWOODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29746 SOUTHFIELD RD # 302
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2088
Mailing Address - Country:US
Mailing Address - Phone:313-629-8425
Mailing Address - Fax:
Practice Address - Street 1:29746 SOUTHFIELD RD # 302
Practice Address - Street 2:302
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2088
Practice Address - Country:US
Practice Address - Phone:313-629-8425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2701181221335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376998682Medicaid