Provider Demographics
NPI:1952430050
Name:SCARLETT, DALE C (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:C
Last Name:SCARLETT
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 1:99 ELM PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1009
Mailing Address - Country:US
Mailing Address - Phone:248-854-8355
Mailing Address - Fax:
Practice Address - Street 1:99 ELM PARK AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT RIDGE
Practice Address - State:MI
Practice Address - Zip Code:48069-1009
Practice Address - Country:US
Practice Address - Phone:248-854-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4698660Medicaid
MID91394Medicare UPIN
MI0N97197180Medicare ID - Type Unspecified