Provider Demographics
NPI:1831382407
Name:BLUE CARE NETWORK OF MICHIGAN
Entity type:Organization
Organization Name:BLUE CARE NETWORK OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECP.
Authorized Official - Prefix:
Authorized Official - First Name:KATHY DOLL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-322-8061
Mailing Address - Street 1:1401 S CREYTS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8507
Mailing Address - Country:US
Mailing Address - Phone:517-322-8049
Mailing Address - Fax:517-322-4486
Practice Address - Street 1:1401 S CREYTS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8507
Practice Address - Country:US
Practice Address - Phone:517-322-8049
Practice Address - Fax:517-322-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18503122300000X
MI18854122300000X
MA18754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID800318OtherBCBSM