Provider Demographics
NPI:1821387366
Name:LODER, CHARISSE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:MARIE
Last Name:LODER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-936-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106814207V00000X, 207VC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology