MEDICARE: DR. RYAN E DODDE II M.D.

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	208200000X	Plastic Surgery Physician	4301063317	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07010911	OTHER	MI	BLUE CROSS PIN NUMBER
2	13-30028	OTHER	MI	IBA INSURANCE ID NUMBER
3	128516	OTHER	MI	PREFERRED CHOICES ID NO.
4	2221956	OTHER	MI	CIGNA PPO ID NUMBER
5	7254148	OTHER	MI	AETNA ID NUMBER
6	24-07010911	OTHER	MI	BCBS ID NUMBER

General Provider Information

NPI Number	:	1881669299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN E DODDE II M.D.

Provider Business Mailing Address
First Line	:	3124 N WELLNESS DR
Second Line	:	SUITE 10
City	:	HOLLAND
State	:	MI
Zip	:	49424-8121
Country	:	US
Telephone Number	:	616-738-5870
Fax Number	:	616-738-5872

Provider Business Practice Location Address
First Line	:	3124 N WELLNESS DR
Second Line	:	SUITE 10
City	:	HOLLAND
State	:	MI
Zip	:	49424-8121
Country	:	US
Telephone Number	:	616-738-5870
Fax Number	:	616-738-5872

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	10/17/2007

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Directions to “ DR. RYAN E DODDE II M.D.” Practice Location

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