Provider Demographics
NPI:1669854659
Name:DEWEERT, DANIEL JOHN (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:DEWEERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43065 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3685
Mailing Address - Country:US
Mailing Address - Phone:309-838-0480
Mailing Address - Fax:
Practice Address - Street 1:19401 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:800-653-6568
Practice Address - Fax:313-982-8668
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01079524A207P00000X
MI4301114012207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine