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NPI Code Detail

MEDICARE: DR. EDWARD P. FODY M.D.

MEDICARE: DR. EDWARD P. FODY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician4301084665MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619950649
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD P. FODY M.D.
Provider Business Mailing Address
First Line : 5700 SOUTHWYCK BLVD
Second Line :
City : TOLEDO
State : OH
Zip : 43614-1509
Country : US
Telephone Number : 800-288-8325
Fax Number : 419-866-5453
Provider Business Practice Location Address
First Line : 602 MICHIGAN AVE
Second Line :
City : HOLLAND
State : MI
Zip : 49423-4918
Country : US
Telephone Number : 517-403-0763
Fax Number : 800-576-8369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 01/23/2014

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