NPIMap

Individual provider Active NPI

Michael Dewall, DO

  • Dermatopathology Physician
  • Ypsilanti, MI
National Provider Identifier
1679968150
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
5101025453 Issued in MI
Practice address
5301 E Huron River Dr
Ypsilanti, MI 48197-1051
Phone
(734) 712-3161
Fax
(734) 712-2244
NPI assigned
Apr 1, 2015
Last updated
Dec 15, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 5101025453 MI
Dermatopathology Physician 207ND0900X 5101025453 MI Primary
Clinical Pathology Physician 207ZC0006X 5101025453 MI

Addresses

Primary practice location

5301 E Huron River Dr
Ypsilanti, MI 48197-1051

Mailing address

24 Frank Lloyd Wright Dr Lbby J2000
Ann Arbor, MI 48105-9484
Phone (734) 747-6766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200420001549 MI Practitioner - Pathology 1759697162 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

5301 E Huron River Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-4108

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101025453MIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Services Corporation Multi-Specialty Current Accepting new patients
Iha Health Services Corporation Multi-Specialty CurrentSince Jun 1, 2020 Accepting new patients
Iha Health Service Corporation Multi-Specialty CurrentSince Jun 1, 2020 Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

14650 E Old US Highway 12
Ste Hia
Chelsea, MI 48118

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1679968150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR LBBY J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 E HURON RIVER DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971051",
            "telephone_number": "734-712-3161",
            "fax_number": "734-712-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWALL",
        "first_name": "MICHAEL",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-01",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5101025453",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "MI",
            "license": "5101025453",
            "primary": true
        },
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "MI",
            "license": "5101025453",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.