Provider Demographics
NPI:1558307926
Name:E MICHAEL LODISH DO PC
Entity Type:Organization
Organization Name:E MICHAEL LODISH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LODISH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-573-3127
Mailing Address - Street 1:3272 E 12 MILE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-5622
Mailing Address - Country:US
Mailing Address - Phone:586-573-3127
Mailing Address - Fax:586-573-3130
Practice Address - Street 1:3272 E 12 MILE RD
Practice Address - Street 2:STE 102
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5622
Practice Address - Country:US
Practice Address - Phone:586-573-3127
Practice Address - Fax:586-573-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI118395OtherGREATLAKEHEALTHPLAN
MIM004233OtherTRICARE
MI0255011674OtherBCBSM
MI1899208Medicaid
MI49119OtherOMNICARE COVENTRY
MI000000003077OtherCAPEHEALTHPLAN
MI107509OtherCARECHOICES/PREFERREDCHOI
MI3689470001OtherCIGNA
MIE37392OtherHAP
MI1533202OtherUNITED MINEWORKERS
MI4110309OtherAETNA PPO
MI000000003077OtherCAPEHEALTHPLAN
MIM004233OtherTRICARE