Provider Demographics
NPI:1366556714
Name:JOHN P DOHM PLLC
Entity type:Organization
Organization Name:JOHN P DOHM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOHM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-853-3651
Mailing Address - Street 1:7201 W SAGINAW HWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1131
Mailing Address - Country:US
Mailing Address - Phone:517-853-3651
Mailing Address - Fax:
Practice Address - Street 1:7201 W SAGINAW HWY
Practice Address - Street 2:SUITE 305
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1131
Practice Address - Country:US
Practice Address - Phone:517-853-3651
Practice Address - Fax:517-853-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0152300334OtherBCBS OF MICHIGAN
MI114478086Medicaid
MIF03673Medicare UPIN
MI114478086Medicaid