Provider Demographics
NPI:1770507741
Name:DOHM, JOHN PHILLIP (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILLIP
Last Name:DOHM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2380 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2143
Mailing Address - Country:US
Mailing Address - Phone:517-742-4922
Mailing Address - Fax:517-699-2904
Practice Address - Street 1:2380 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2143
Practice Address - Country:US
Practice Address - Phone:517-742-4922
Practice Address - Fax:517-699-2904
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C36097OtherTRAVELERS MEDICARE
MI4478086Medicaid
MI0C360971062Medicare PIN
MI0C36097OtherTRAVELERS MEDICARE