Organization
SAGINAW VALLEY DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID BRIAN O'DONNELL M.D. (PRESIDENT)
(989) 793-6505
Entity
Organization
Contact information
Practice address
4705 TOWNE CENTRE RD, SUITE 301, SAGINAW, MI 48604-2818
(989) 793-6505
(989) 793-7411
Mailing address
4705 TOWNE CENTRE RD, SUITE 301, SAGINAW, MI 48604-2818
(989) 793-6505
(989) 793-7411
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
DO049303
MI
207ND0101X
MOHS-Micrographic Surgery Physician
DO049303
MI
207ND0900X
Dermatopathology Physician
DO049303
MI
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
DO049303
MI
207NS0135X
Procedural Dermatology Physician
DO049303
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070006809
RAILROAD MEDICARE
MI
01
—
0707324351
BLUE CROSS BLUE SHIELD
MI
05
—
103082897
—
MI
Enumeration date
04/05/2006
Last updated
05/27/2008
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