Provider Demographics
NPI:1952305765
Name:DODDS, ROBERT GERALD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GERALD
Last Name:DODDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY STE 260
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3275
Mailing Address - Country:US
Mailing Address - Phone:248-737-4600
Mailing Address - Fax:248-538-5020
Practice Address - Street 1:30055 NORTHWESTERN HWY STE 260
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3275
Practice Address - Country:US
Practice Address - Phone:248-737-4600
Practice Address - Fax:248-538-5020
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063275207V00000X
MI43010363275207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI345712510Medicaid
MIG68807Medicare UPIN
MIF36022058Medicare ID - Type UnspecifiedPROVIDER ID