Unknown Individual – Foot & Ankle Surgery Podiatrist, NPI 1255363065

Unknown Individual is a healthcare provider. based in Macomb, Michigan. specializing in Foot & Ankle Surgery Podiatrist. They hold a License No. MC0001096 (MI). The NPI Number for Unknown Individual is 1255363065

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1255363065
Phone
(586) 263-8181
Address
16700 21 MILE RD
Deactivation Date
3 August 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1982 (44 years ago)
PAC ID
2264548403
Professional Enrollment ID
I20101207000970
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

  • 16700, 21 Mile Road, Macomb Township, Macomb County, Michigan, 48044, United States

    SUITE #102

    MACOMB, MI 480444887

    Phone: (586) 263-8181

    Fax: (586) 263-1461

    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 48044)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1255363065 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Foot & Ankle Surgery Podiatrist. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Macomb, Michigan as the reference point for Unknown Individual, then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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