Healthcare Provider Details

I. General information

NPI: 1023233384
Provider Name (Legal Business Name): DOUGLAS MATTHEW IDDINGS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 KENSINGTON AVE
FLINT MI
48503-2044
US

IV. Provider business mailing address

302 KENSINGTON AVE
FLINT MI
48503-2044
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-8092
  • Fax: 810-762-8892
Mailing address:
  • Phone: 810-762-8092
  • Fax: 810-762-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number5101014246
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: