Provider Demographics
NPI:1124293998
Name:HELENE C. DOMBROWSKI, M.D., P.C.
Entity type:Organization
Organization Name:HELENE C. DOMBROWSKI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOMBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-563-6655
Mailing Address - Street 1:23100 CHERRY HILL ST STE 10
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1449
Mailing Address - Country:US
Mailing Address - Phone:313-563-6655
Mailing Address - Fax:313-563-5517
Practice Address - Street 1:23100 CHERRY HILL ST STE 10
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1449
Practice Address - Country:US
Practice Address - Phone:313-563-6655
Practice Address - Fax:313-563-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHD406059207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0708251301OtherBCBSM
MIE77890Medicare UPIN
MI0823976Medicare PIN