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General NPI Number Information
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NPI Number | 1245574920
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Entity Type | Organization
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Legal Business Name | GI HEALTH & WELLNES PC
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 27500 HOOVER RD
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City | WARREN
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State | MI
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Zip | 48093-4586
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Country | US
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Telephone | 586-755-1626
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44047
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City | DETROIT
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State | MI
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Zip | 48244-0047
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Country | US
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Telephone | 586-755-1626
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MICHELE K. DODMAN
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Credential | DO
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Telephone | 586-755-1626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | MI
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