Basic Information
| Provider Information | |||||||||
| NPI: | 1750484390 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLORIDO | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 BYRON CENTER AVE SW | ||||||||
| Address2: | MEDICAL ADMINISTRATION | ||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495199606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162523243 | ||||||||
| FaxNumber: | 6162520260 | ||||||||
| Practice Location | |||||||||
| Address1: | 2221 HEALTH DR SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495199650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165325025 | ||||||||
| FaxNumber: | 6165326126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 12/08/2017 | ||||||||
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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 | 207V00000X | 5101013843 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4473615 | 05 | MI | MEDICAID | 1654102875 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 4473633 | 05 | MI | MEDICAID | 4424165 | 05 | MI | MEDICAID | 1654102875 | 01 | MI | BLUE CARE NETWORK | OTHER |