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General NPI Number Information
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NPI Number | 1699125260
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Entity Type | Individual
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Provider Name | JONATHAN STODDARD M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 37595 7 MILE RD STE 210
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City | LIVONIA
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State | MI
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Zip | 48152-1489
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Country | US
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Telephone | 734-853-5694
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Fax | 734-430-9388
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR STE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone | 734-747-6766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0116029023
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 4301513427
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License Number State | MI
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