Provider Demographics
NPI:1881864023
Name:MICHIGAN REPRODUCTIVE AND IVF CENER, PC
Entity Type:Organization
Organization Name:MICHIGAN REPRODUCTIVE AND IVF CENER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:616-988-2229
Mailing Address - Street 1:3230 EAGLE PARK DR NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7007
Mailing Address - Country:US
Mailing Address - Phone:616-988-2229
Mailing Address - Fax:616-988-2010
Practice Address - Street 1:3230 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7007
Practice Address - Country:US
Practice Address - Phone:616-988-2229
Practice Address - Fax:616-988-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207VE0102X207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty