Provider Demographics
NPI:1881669299
Name:DODDE, RYAN E II (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:E
Last Name:DODDE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3124 N WELLNESS DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8121
Mailing Address - Country:US
Mailing Address - Phone:616-738-5870
Mailing Address - Fax:616-738-5872
Practice Address - Street 1:3124 N WELLNESS DR
Practice Address - Street 2:SUITE 10
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8121
Practice Address - Country:US
Practice Address - Phone:616-738-5870
Practice Address - Fax:616-738-5872
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063317208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI07010911OtherBLUE CROSS PIN NUMBER
MI13-30028OtherIBA INSURANCE ID NUMBER
MI128516OtherPREFERRED CHOICES ID NO.
MI2221956OtherCIGNA PPO ID NUMBER
MI7254148OtherAETNA ID NUMBER
MI24-07010911OtherBCBS ID NUMBER
MIH15214Medicare UPIN
MIP2163001Medicare PIN