Unknown Individual – Internal Medicine Physician, NPI 1528058807

Unknown Individual is a healthcare provider. based in Moline, Illinois. specializing in Internal Medicine Physician. They hold a License No. 036070802 (IL). The NPI Number for Unknown Individual is 1528058807

Main info

Organization
Inactive
46 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1528058807
Phone
(309) 792-2100
Address
4350 7TH ST STE A
Deactivation Date
8 May 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3097922100
Graduation Year
1980 (46 years ago)
PAC ID
3476552332
Professional Enrollment ID
I20061204000503
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 4350 7TH ST STE A

    MOLINE, IL 612656870

    Phone: (309) 792-2100

    Fax: (309) 792-2108

    Type: Mailing

  • 4350, 7th Street, Moline, Rock Island County, Illinois, 61265, United States

    MOLINE, IL 61265

    Phone: (309) 792-2100

    Fax: (309) 792-2108

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 61265)

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Provider's Procedures

Unknown Individual performs procedures in Internal Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINEIL81002Urinalysis, manual test1511

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1528058807 for Unknown Individual.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Moline, Illinois. Check all listed addresses for suites or satellite offices.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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