Basic Information
| Provider Information | |||||||||
| NPI: | 1669854659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEWEERT | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43065 RIVER BEND DR | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481703685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098380480 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19401 HUBBARD DR | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006536568 | ||||||||
| FaxNumber: | 3139828668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2015 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01079524A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 4301114012 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.