Healthcare Provider Details

I. General information

NPI: 1881864023
Provider Name (Legal Business Name): MICHIGAN REPRODUCTIVE AND IVF CENER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 EAGLE PARK DR NE SUITE 100
GRAND RAPIDS MI
49525-7007
US

IV. Provider business mailing address

3230 EAGLE PARK DR NE SUITE 100
GRAND RAPIDS MI
49525-7007
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-2229
  • Fax: 616-988-2010
Mailing address:
  • Phone: 616-988-2229
  • Fax: 616-988-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number207VE0102X
License Number StateMI

VIII. Authorized Official

Name: WILLIAM G DODDS II
Title or Position: PHYSICIAN
Credential: MD
Phone: 616-988-2229