MEDICARE: DR. JOHN PHILLIP DOHM D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101009130	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0C36097	OTHER	MI	TRAVELERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770507741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PHILLIP DOHM D.O.

Provider Business Mailing Address
First Line	:	2380 CEDAR ST
Second Line	:
City	:	HOLT
State	:	MI
Zip	:	48842-2143
Country	:	US
Telephone Number	:	517-742-4922
Fax Number	:	517-699-2904

Provider Business Practice Location Address
First Line	:	2380 CEDAR ST
Second Line	:
City	:	HOLT
State	:	MI
Zip	:	48842-2143
Country	:	US
Telephone Number	:	517-742-4922
Fax Number	:	517-699-2904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	06/05/2015

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