Basic Information
| Provider Information | |||||||||
| NPI: | 1487755971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPENDER | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3490 CALKINS RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107337741 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 COLUMBUS AVE | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487086831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107337741 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 4301045740 | MI | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 4124070 | 01 | MI | HEALTHPLAN OF MI | OTHER | 4124070 | 05 | MI | MEDICAID | 0984752 | 01 | MI | HEALTHPLUS OF MI | OTHER | 220025771 | 01 | MI | RAILROAD MEDICARE | OTHER | 4124070 | 01 | MI | MOLINA HEALTHCARE | OTHER | 1010923 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 28882 | 01 | MI | COMMUNITY CHOICE MI | OTHER |