NPIMap

Organization Active NPI

Peter C. Dodenhoff DO PC

  • Family Medicine Physician
  • Eastpointe, MI
National Provider Identifier
1770754822
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
PD006192 Issued in MI
Legal business name
PETER C. DODENHOFF DO PC
Practice address
21811 Kelly Rd
Suite 107
Eastpointe, MI 48021-2793
Phone
(586) 773-0200
Fax
(586) 773-9803
NPI assigned
Mar 17, 2008
Last updated
Mar 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

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

Authorized official

Name
Dr. Peter Dodenhoff, DONPI 1174544928
Title
Owner
Phone
(586) 773-0200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X PD006192 MI Primary

Addresses

Primary practice location

21811 Kelly Rd
Suite 107
Eastpointe, MI 48021-2793

Mailing address

21811 Kelly Rd
Suite 107
Eastpointe, MI 48021-2793
Phone (586) 773-0200

Other identifiers 2

IdentifierTypeStateIssuer
1174544928MedicaidMI
0255012095OtherMIBCBS

National Provider Directory

National Provider Directory

Locations

21811 Kelly Rd
Ste 107
Eastpointe, MI 48021
Phone (586) 773-0200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205712000000",
    "number": "1770754822",
    "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": "480212793",
            "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": "480212793",
            "telephone_number": "586-773-0200",
            "fax_number": "586-773-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER C. DODENHOFF DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "DODENHOFF",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-773-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "PD006192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174544928",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0255012095",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastpointe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; 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.