MEDICARE: DR. JODI S FLANDERS DO

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	5101008105	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0157800015	OTHER	MI	BCBSM INDIVIDUAL PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912920984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI S FLANDERS DO

Provider Business Mailing Address
First Line	:	1457 N. M-52
Second Line	:	UNIT 2
City	:	OWOSSO
State	:	MI
Zip	:	48867-1277
Country	:	US
Telephone Number	:	989-723-5136
Fax Number	:	989-723-8269

Provider Business Practice Location Address
First Line	:	1457 N. M-52
Second Line	:	UNIT 2
City	:	OWOSSO
State	:	MI
Zip	:	48867-1277
Country	:	US
Telephone Number	:	989-723-5136
Fax Number	:	989-723-8269

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/18/2013

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