Provider Demographics
NPI:1538187505
Name:DODT, KEVEN W (MD)
Entity type:Individual
Prefix:DR
First Name:KEVEN
Middle Name:W
Last Name:DODT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:3920 ST FRANCIS WAY STE 209
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4917
Practice Address - Country:US
Practice Address - Phone:765-775-2830
Practice Address - Fax:765-775-2826
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01025332207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100097640Medicaid
INB28388Medicare UPIN
IN100097640Medicaid
IN220170SMedicare PIN