Basic Information
| Provider Information | |||||||||
| NPI: | 1033160502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DODDS | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 HANNAH BLVD | ||||||||
| Address2: | STE 212 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173191831 | ||||||||
| FaxNumber: | 5176642930 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 HANNAH BLVD | ||||||||
| Address2: | STE 212 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173191831 | ||||||||
| FaxNumber: | 5176642930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 09/22/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 4301058595 | MI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200000001893 | 01 | MI | PHP | OTHER | 200000001893 | 01 | MI | PHP FAMILYCARE | OTHER | 4764980 | 05 | MI | MEDICAID | 1016065 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 4224321 | 01 | MI | AETNA | OTHER | 0M21440043 | 01 | MI | MEDICARE PLUS BLUE | OTHER | 1016065 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 1016065 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | 2003302131 | 01 | MI | BCBS/BCN | OTHER |