Provider Demographics
NPI:1114983426
Name:DODDS, WILLIAM G (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:DODDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 EAGLE PARK DR NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7047
Mailing Address - Country:US
Mailing Address - Phone:616-988-2229
Mailing Address - Fax:616-988-2010
Practice Address - Street 1:3230 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7047
Practice Address - Country:US
Practice Address - Phone:616-988-2229
Practice Address - Fax:616-988-2010
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2770281Medicaid
MID17634Medicare UPIN
MID17634Medicare ID - Type Unspecified