Basic Information
| Provider Information | |||||||||
| NPI: | 1700855475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEW | ||||||||
| FirstName: | ANTJE | ||||||||
| MiddleName: | SOUTHWICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 TIMBER RIDGE DR SE | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493019359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166822045 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3152 PORT SHELDON ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HUDSONVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494269297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166699238 | ||||||||
| FaxNumber: | 6166698296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301078492 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.