Individual
MICHAEL DEWALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5301 E HURON RIVER DR, YPSILANTI, MI 48197-1051
(734) 712-3161
(734) 712-2244
Mailing address
24 FRANK LLOYD WRIGHT DR LBBY J2000, ANN ARBOR, MI 48105-9484
(734) 747-6766
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
5101025453
MI
207ND0900X
Dermatopathology Physician
Primary
5101025453
MI
207ZC0006X
Clinical Pathology Physician
5101025453
MI
Other
Enumeration date
04/01/2015
Last updated
12/15/2020
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