Healthcare Provider Details

I. General information

NPI: 1003802570
Provider Name (Legal Business Name): JODY C RHAMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 KIMOLE LN SUITE 230
ADRIAN MI
49221-1478
US

IV. Provider business mailing address

777 KIMOLE LN SUITE 230
ADRIAN MI
49221-1478
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-5655
  • Fax: 517-263-8012
Mailing address:
  • Phone: 517-263-5655
  • Fax: 517-263-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301075052
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: