Unknown Individual – Family Medicine Physician, NPI 1194702878

Unknown Individual is a healthcare provider. based in Norton shores, Michigan. specializing in Family Medicine Physician. They hold a License No. 5101013853 (MI). The NPI Number for Unknown Individual is 1194702878

Main info

Organization
Inactive
28 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1194702878
Phone
(231) 672-6700
Address
3587 HENRY ST STE 200
Deactivation Date
11 November 2020

Doctor Profile

Medical School Name
MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
8558407257
Graduation Year
1998 (28 years ago)
PAC ID
7618905977
Group Practice PAC ID
9638422835
Professional Enrollment ID
I20050728001016
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

Provider Addresses for Unknown Individual

  • 3587 HENRY ST STE 200

    NORTON SHORES, MI 494416732

    Phone: (231) 672-6700

    Fax: (231) 672-6749

    Type: Location

  • US Post Office - North Muskegon, 404, Center Street, North Muskegon, Muskegon County, Michigan, 49445, United States

    MUSKEGON, MI 494431848

    Phone: (231) 727-4444

    Fax: (231) 728-4789

    Type: Mailing

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 49441)

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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: 9638422835View full group profile
NameSpecialtyState
Nurse PractitionerMI
Nurse PractitionerMI
Nurse PractitionerMI
Family PracticeMI
Nurse PractitionerMI
Nurse PractitionerMI
-MI
Nurse PractitionerMI
Nurse PractitionerIL
Nurse PractitionerMI

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1194702878 for Unknown Individual, then check state licensing separately.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Family Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Norton Shores, Michigan may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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