Unknown Individual – Radiation Oncology Physician, NPI 1073543294

Unknown Individual is a healthcare provider. based in East lansing, Michigan. specializing in Radiation Oncology Physician. They hold a License No. 5101011401 (MI). The NPI Number for Unknown Individual is 1073543294

Main info

Organization
Inactive
35 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1073543294
Phone
(269) 567-9835
Address
6411 PINE HOLLOW DR
Deactivation Date
30 January 2025

Doctor Profile

Medical School Name
MIDWESTERN UNIVERSITY, CHICAGO COLLEGE OF OSTEOPATHIC MED
Secondary Phone
5173642287
Graduation Year
1991 (35 years ago)
PAC ID
8123121779
Group Practice PAC ID
1254434806
Professional Enrollment ID
I20100916000056
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

  • 6411 PINE HOLLOW DR

    EAST LANSING, MI 488239737

    Phone: (269) 567-9835

    Fax: (269) 567-9841

    Type: Mailing

  • Sparrow Hospital, 1215, East Michigan Avenue, Lansing, Lansing Charter Township, Ingham County, Michigan, 48912, United States

    LANSING, MI 489121811

    Phone: (517) 364-9412

    Fax: (517) 364-2788

    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.

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes5849$0
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Insurance plans in this area (ZIP 48823)

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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: 1254434806View full group profile
NameSpecialtyState
-MI

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1073543294 when you need to reference Unknown Individual in forms, claims, or directories.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Radiation Oncology Physician. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes East Lansing, Michigan for Unknown Individual; expand the address list for detail.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1073543294. Always confirm identity and privileges with the practice and licensing boards.

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