Basic Information
| Provider Information | |||||||||
| NPI: | 1013949650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PODOLSKY | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | OWEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 SOUTH DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488583256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897733411 | ||||||||
| FaxNumber: | 9897753187 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 SOUTH DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488583256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897733411 | ||||||||
| FaxNumber: | 9897753187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 06/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | SP064843 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 104353850 | 05 | MI | MEDICAID | 160C71016 | 01 | MI | BCBS GROUP# | OTHER |