Provider Demographics
NPI:1730747494
Name:KIDDER, IAN JEOFFRY (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:JEOFFRY
Last Name:KIDDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1500 E MEDICAL CENTER DR SPC 5226
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5000
Mailing Address - Country:US
Mailing Address - Phone:602-690-2246
Mailing Address - Fax:734-615-2156
Practice Address - Street 1:1500 E. MEDICAL CENTER DRIVE
Practice Address - Street 2:SPC 5226
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5226
Practice Address - Country:US
Practice Address - Phone:734-647-5899
Practice Address - Fax:734-615-2156
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-49865207R00000X, 208M00000X
MI4301508876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist