Basic Information
| Provider Information | |||||||||
| NPI: | 1366404600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TODD | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 912 S WASHINGTON AVE | ||||||||
| Address2: | STE 1 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486012578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E MEDICAL CENTER DR | ||||||||
| Address2: | 2ND FLOOR TAUBMAN CENTER RECP F | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349365738 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD61225865 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 226727-1 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 4301094103 | MI | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 4301094103 | MI | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 02695563 | 05 | NY | MEDICAID |