Basic Information
Provider Information
NPI: 1982046926
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DESS
FirstName: ROBERT
MiddleName: TIMOTHY
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481081633
CountryCode: US
TelephoneNumber: 7346475299
FaxNumber:  
Practice Location
Address1: 7500 CHALLIS RD
Address2:  
City: BRIGHTON
State: MI
PostalCode: 481169416
CountryCode: US
TelephoneNumber: 8102634000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/18/2013
LastUpdateDate: 12/27/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001X4301104722MIY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

No ID Information.


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