Provider Demographics
NPI:1851594659
Name:DODSON-HUNT, KELLI JEANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:JEANNE
Last Name:DODSON-HUNT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KELLI
Other - Middle Name:JEANNE
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5629 STADIUM DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1952
Mailing Address - Country:US
Mailing Address - Phone:269-372-1000
Mailing Address - Fax:269-372-0698
Practice Address - Street 1:5629 STADIUM DR
Practice Address - Street 2:SUITE A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1952
Practice Address - Country:US
Practice Address - Phone:269-372-1000
Practice Address - Fax:269-372-0698
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016736390200000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1851594659Medicaid
MI0C910950OtherBCBSM