Individual
NANCY N DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
35 MICHIGAN ST NE, SUITE 3003, GRAND RAPIDS, MI 49503-2514
(616) 267-2009
(616) 267-2010
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
4301087152
MI
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
4301087152
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3504115821
BCBSM
MI
05
—
4845247
—
MI
Enumeration date
05/18/2006
Last updated
10/07/2022
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