Provider Demographics
NPI:1841281532
Name:DORMAN, MICHAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:DORMAN
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 1:6330 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2398
Mailing Address - Country:US
Mailing Address - Phone:248-855-3366
Mailing Address - Fax:248-855-6213
Practice Address - Street 1:6330 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2398
Practice Address - Country:US
Practice Address - Phone:248-855-3366
Practice Address - Fax:248-855-6213
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056439207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF37225002Medicare PIN