Peter Charles Dodenhoff, DO, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101006192 Issued in MI

Practice address

21811 Kelly Rd
Suite 107
Eastpointe, MI 48021

Phone

(586) 773-0200

Fax

(586) 773-9803

NPI assigned

Jul 21, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260748800000",
    "number": "1174544928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21811 KELLY RD",
            "address_2": "SUITE 107",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "48021",
            "telephone_number": "586-773-0200",
            "fax_number": "586-773-9803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21811 KELLY RD",
            "address_2": "SUITE 107",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "48021",
            "telephone_number": "586-773-0200",
            "fax_number": "586-773-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODENHOFF",
        "first_name": "PETER",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DO, PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2009-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101006192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "55033895",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1075599110",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Douglas G. Hames M.D., P.C.

• Family Medicine Physician in Eastpointe, MI
• Providers in Eastpointe, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.