Provider Demographics
NPI:1093160798
Name:RIGGINS-WODHOUSE, JOANN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:RIGGINS-WODHOUSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:WOODHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3495 PINE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1956
Mailing Address - Country:US
Mailing Address - Phone:248-895-2218
Mailing Address - Fax:
Practice Address - Street 1:3495 PINE ESTATES DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1956
Practice Address - Country:US
Practice Address - Phone:248-895-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-01
Last Update Date:2016-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine