Basic Information
| Provider Information | |||||||||
| NPI: | 1952378358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DASHER | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 10090 E LIPPINCOTT BLVD | ||||||||
| Address2: | |||||||||
| City: | DAVISON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484239151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106531130 | ||||||||
| FaxNumber: | 8106538589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301080058 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01003172 | 01 | MI | HEALTH PLUS | OTHER | 1019346 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | P00295235 | 01 | MI | METRAHEALTH | OTHER | 17477 | 01 | MI | MCARE | OTHER | I49240 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | 1019346 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 4823366 | 05 | MI | MEDICAID |