Unknown Individual – Family Medicine Physician, NPI 1063414076

Unknown Individual is a healthcare provider. based in Howell, Michigan. specializing in Family Medicine Physician. They hold a License No. 5101014703 (MI). The NPI Number for Unknown Individual is 1063414076

Main info

Organization
Inactive
26 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1063414076
Phone
(517) 548-0010
Address
1225 W GRAND RIVER AVE
Deactivation Date
17 October 2022

Doctor Profile

Medical School Name
MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
5175480010
Graduation Year
2000 (26 years ago)
PAC ID
7012966724
Group Practice PAC ID
2860441573
Professional Enrollment ID
I20050121000364
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

  • 1225, West Grand River Avenue, Howell, Livingston County, Michigan, 48843, United States

    SUITE 300

    HOWELL, MI 488433975

    Phone: (517) 548-0010

    Fax: (517) 548-5326

    Mailing address matches the actual address.

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.

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 48843)

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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: 2860441573View full group profile
NameSpecialtyState
-MI

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1063414076.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
How should patients interpret Unknown Individual's specialty?
The extract shows Family Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Howell, Michigan?
If you are local to Howell, Michigan, Unknown Individual may be relevant to your search.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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