Basic Information
| Provider Information | |||||||||
| NPI: | 1003802570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHAMES | ||||||||
| FirstName: | JODY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 KIMOLE LN | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172635655 | ||||||||
| FaxNumber: | 5172638012 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 KIMOLE LN | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172635655 | ||||||||
| FaxNumber: | 5172638012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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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 | 207Q00000X | 4301075052 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000378442 | 01 | ANTHEM | OTHER | 0804601681 | 01 | BCBS MI | OTHER | P00254434 | 01 | RRMC | OTHER | 7121036 | 01 | AETNA | OTHER | 125902 | 01 | CARECHOICES/PREFERRED CHO | OTHER | 4783565 | 05 | MI | MEDICAID |