Provider Demographics
NPI:1659364974
Name:DODMAN, MICHELE K (DO)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:K
Last Name:DODMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7890 N CORTARO RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-8326
Mailing Address - Country:US
Mailing Address - Phone:520-202-7770
Mailing Address - Fax:520-202-7773
Practice Address - Street 1:1521 E TANGERINE RD STE 123
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6214
Practice Address - Country:US
Practice Address - Phone:520-901-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007543207RG0100X
MI5101010430207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3196154Medicaid
MI5333897Medicare ID - Type Unspecified
MI3196154Medicaid