Provider Demographics
NPI:1598975021
Name:PAGADUAN-ODDO, GRACE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:PAGADUAN-ODDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:MARIE
Other - Last Name:PAGADUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2590 ELIZABETH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3314
Mailing Address - Country:US
Mailing Address - Phone:248-738-5500
Mailing Address - Fax:248-738-5506
Practice Address - Street 1:2590 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3314
Practice Address - Country:US
Practice Address - Phone:248-738-5500
Practice Address - Fax:248-738-5506
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine