Provider Demographics
NPI:1073855482
Name:GARVIN, JODI K (DO)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:K
Last Name:GARVIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:HELEN DE VOS CHILDREN'S HOSPITAL NICU 3W
Mailing Address - Street 2:100 MICHIGAN ST NE
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HELEN DE VOS CHILDREN'S HOSPITAL NICU 3W
Practice Address - Street 2:100 MICHIGAN ST NE
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-1370
Practice Address - Fax:616-391-1332
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MI53150963552080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program