Provider Demographics
NPI:1083677066
Name:DODARD, MICHEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:J
Last Name:DODARD
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1475 NW 12TH AVE
Mailing Address - Street 2:BOX 016960 M851
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1002
Mailing Address - Country:US
Mailing Address - Phone:305-243-7249
Mailing Address - Fax:305-243-8470
Practice Address - Street 1:1475 NW 12TH AVE
Practice Address - Street 2:BOX 016960 M851
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1002
Practice Address - Country:US
Practice Address - Phone:305-243-7249
Practice Address - Fax:305-243-8470
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME50681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0488461-00Medicaid
FL0488461-00Medicaid
FL07491Medicare PIN