Organization
KEITH J MOODY D O P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH J MOODY D O D O (OWNER)
(989) 893-9705
Entity
Organization
Contact information
Practice address
200 S WENONA ST, SUITE 225, BAY CITY, MI 48706-8820
(989) 893-9705
(989) 893-8206
Mailing address
200 S WENONA ST, SUITE 225, BAY CITY, MI 48706-8820
(989) 893-9705
(989) 893-8206
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101008328
MI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
5101008328
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1006214
MCLAREN HEALTH PLAN
—
01
—
1150900464
BLUE CROSS BLUE SHIELD MI
—
01
—
16613
COMMUNITY CHOICE
—
01
—
28233
PRIORITY HEALTH
—
05
—
4164290
—
MI
01
—
4220040
AETNA
—
01
—
50900464
BLUE CARE NETWORK
—
Enumeration date
11/28/2007
Last updated
11/28/2007
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