MARTIAL FOTSO (MD) – Family Medicine Physician, NPI 1023758968

MARTIAL FOTSO (MD) is a healthcare provider. based in Southfield, Michigan. specializing in FAMILY PRACTICE. They hold the professional credentials MD. They hold a License No. 2025030537 (MO). The NPI Number for MARTIAL FOTSO (MD) is 1023758968

Main info

Male
10 Years Of Experience
Accepts Medicare Assignment
Name
MARTIAL FOTSO (MD)
NPI
1023758968
Phone
(248) 849-3447
Address
22250 PROVIDENCE DR STE 557
Enumeration Date
30 March 2022
Last Update Date
8 September 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6369338091
Graduation Year
2016 (10 years ago)
PAC ID
4981084001
Group Practice PAC ID
8628205598
Professional Enrollment ID
I20250915004072
Address ID
MO630284100FE1400X61XX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience37
Completeness85
Years active:4State licenses:1Digital endpointsOther names

4,418 FAMILY PRACTICE in MI

Provider Addresses for MARTIAL FOTSO (MD)

  • 22250 PROVIDENCE DR STE 557

    SOUTHFIELD, MI 480756213

    Phone: (248) 849-3447

    Fax: (248) 849-8021

    Type: Mailing

  • 1400 US HIGHWAY 61 STE H1521

    FESTUS, MO 630284100

    Phone: (636) 933-5337

    Fax: (636) 933-8090

    Type: Mailing

  • 1400 US HIGHWAY 61

    FESTUS, MO 630284100

    Phone: (636) 933-5337

    Fax: (636) 933-8090

    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.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-09-15

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250915004072IFamily PracticeMOTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

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 48075)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8628205598View full group profile
NameSpecialtyState
Family PracticeCA
-WI
Internal MedicineMO
Nurse PractitionerMO
Internal MedicineMI
Nurse PractitionerMO
Internal MedicineMO
Nurse PractitionerMO
Hospitalist, Internal MedicineMO
Nurse PractitionerMO

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Can I cross-check MARTIAL FOTSO (MD) using NPI 1023758968?
NPI 1023758968 belongs to MARTIAL FOTSO (MD); compare other details if you need extra assurance.
Active or inactive — what applies to MARTIAL FOTSO (MD)?
You should see MARTIAL FOTSO (MD) as active in CMS-hosted NPPES data.
What clinical focus is listed for MARTIAL FOTSO (MD)?
At a glance, MARTIAL FOTSO (MD) is tied to Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is MARTIAL FOTSO (MD) located near Southfield?
MARTIAL FOTSO (MD) currently maps to Southfield, Michigan in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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