Healthcare Provider Details

I. General information

NPI: 1922576214
Provider Name (Legal Business Name): ERIN ELIZABETH O'DOWD CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 COOLIDGE HWY STE 240
TROY MI
48084-7067
US

IV. Provider business mailing address

19335 SILVER SPRING DR APT 204
NORTHVILLE MI
48167-2561
US

V. Phone/Fax

Practice location:
  • Phone: 248-435-9310
  • Fax:
Mailing address:
  • Phone: 313-715-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number20188822
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: