Provider Demographics
NPI:1295785533
Name:GANLEY, JODI ANN (DO)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:ANN
Last Name:GANLEY
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:29992 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:248-851-1430
Mailing Address - Fax:248-851-5182
Practice Address - Street 1:32255 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-723-5880
Practice Address - Fax:248-723-5889
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI51010115992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI130F375610OtherBLUE CROSS BLUE SHIELD
MI700H273300OtherBLUE SHIELD
MI1295785533Medicaid
MI1295785533Medicaid
MIG59080Medicare UPIN