Provider Demographics
NPI:1912920984
Name:FLANDERS, JODI S (DO)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:S
Last Name:FLANDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 N. M-52
Mailing Address - Street 2:UNIT 2
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1277
Mailing Address - Country:US
Mailing Address - Phone:989-723-5136
Mailing Address - Fax:989-723-8269
Practice Address - Street 1:1457 N. M-52
Practice Address - Street 2:UNIT 2
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1277
Practice Address - Country:US
Practice Address - Phone:989-723-5136
Practice Address - Fax:989-723-8269
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0157800015OtherBCBSM INDIVIDUAL PIN
MI3013067Medicaid
MI0157800015OtherBCBSM INDIVIDUAL PIN
MI0G86012001Medicare ID - Type Unspecified