Provider Demographics
NPI:1700956356
Name:DIMSON, RUDYARD LIMSINGIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDYARD
Middle Name:LIMSINGIAN
Last Name:DIMSON
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 1:133 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2308
Mailing Address - Country:US
Mailing Address - Phone:586-468-1600
Mailing Address - Fax:
Practice Address - Street 1:43421 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1133
Practice Address - Country:US
Practice Address - Phone:586-286-5500
Practice Address - Fax:586-286-0900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F56497Medicare UPIN
OM27240Medicare ID - Type Unspecified