Provider Demographics
NPI:1326081266
Name:LODISH, EDWARD MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:LODISH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:24445 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6501
Mailing Address - Country:US
Mailing Address - Phone:248-799-0086
Mailing Address - Fax:248-350-1178
Practice Address - Street 1:24445 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6501
Practice Address - Country:US
Practice Address - Phone:248-799-0086
Practice Address - Fax:248-350-1178
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIEL0053642086X0206X
MI5101005364207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3689470001OtherCIGNA
MI4110309OtherAETNA PPO
MIM004233OtherTRICARE
MI1533202OtherUNITED MINEWORKERS
MI000000003077OtherCAPE HEALTH PLAN
MI118395OtherGREATLAKEHEALTHPLAN
MI1899208Medicaid
MIE37392OtherHAP
MI020025657OtherRAILROAD MEDICARE
MI0255011674OtherBCBSM
MI107509OtherCARECHOICES/PREFERREDCHOI
MI49119OtherOMNICARE COVENTRY
MI1899208Medicaid
MI0255011674OtherBCBSM