Unknown Individual – Family Medicine Physician, NPI 1093767683

Unknown Individual is a healthcare provider. based in Clinton twp, Michigan. specializing in Family Medicine Physician. They hold a License No. 5101014259 (MI). The NPI Number for Unknown Individual is 1093767683

Main info

Organization
Inactive
27 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1093767683
Phone
(586) 285-3800
Address
15717 15 MILE RD
Deactivation Date
23 October 2024

Doctor Profile

Medical School Name
DES MOINES UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES
Secondary Phone
5862632300
Graduation Year
1999 (27 years ago)
PAC ID
1052497856
Group Practice PAC ID
7911808381
Professional Enrollment ID
I20080319000314

Contacts

Secure Messaging
tpham138525@direct.hfhs.org
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • Henry Ford Macomb Health Center - Fraser, 15717, 15 Mile Road, Cady, Clinton Township, Macomb County, Michigan, 48035, United States

    CLINTON TWP, MI 480352101

    Phone: (586) 285-3800

    Fax: (586) 285-3818

    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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes3324$0
36415Insertion of needle into vein for collection of blood sample3128$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit2121$0
99213Established patient office or other outpatient visit, 20-29 minutes1513$0
View full utilization report →

Insurance plans in this area (ZIP 48035)

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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: 7911808381View full group profile
NameSpecialtyState
-MI
Nurse PractitionerMI
Pediatric Medicine, Allergy/ImmunologyMI
Nurse PractitionerMI
-MI
Family PracticeMI
-MI
O B S T E T R I C S/ G Y N E C O L O G YNY
Nurse PractitionerMI
-MI

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1093767683 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Family Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Clinton Twp?
Public fields place Unknown Individual around Clinton Twp, Michigan. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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