Healthcare Provider Details

I. General information

NPI: 1366404600
Provider Name (Legal Business Name): MICHAEL ROBERT TODD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR 2ND FLOOR TAUBMAN CENTER RECP F
ANN ARBOR MI
48109-5332
US

IV. Provider business mailing address

912 S WASHINGTON AVE STE 1
SAGINAW MI
48601-2578
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5738
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD61225865
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number226727-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301094103
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301094103
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: