Unknown Individual – Dermatology Physician, NPI 1275517757

Unknown Individual is a healthcare provider. based in Troy, Michigan. specializing in Dermatology Physician. They hold a License No. 4301032738 (MI). The NPI Number for Unknown Individual is 1275517757

Main info

Organization
Inactive
64 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1275517757
Phone
(248) 649-2330
Address
1559 W BIG BEAVER RD
Deactivation Date
15 May 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1962 (64 years ago)
PAC ID
9739227745
Professional Enrollment ID
I20091112000133
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

  • 1559, West Big Beaver Road, Troy, Oakland County, Michigan, 48084, United States

    STE E 20

    TROY, MI 480843525

    Phone: (248) 649-2330

    Fax: (248) 649-6584

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $122.

Total Amount is formed as General ($122) + Research ($0) + Ownership ($0) = $122.

Last reported payment date: 2023-03-20 • Largest payer in this snapshot: Arcutis Biotherapeutics, Inc. ($122).

Total Amount

$122

General + Research + Ownership

Payments

1

Total payment records

General Amount

$122

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-03-20

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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 minutes202115$0
99212Established patient office or other outpatient visit, 10-19 minutes12474$0
17110Destruction of skin growth, 1-14 growths10961$0
17003Destruction of precancer skin growth, 2-14 growths8216$0
17000Destruction of precancer skin growth, 1 growth5428$0
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Insurance plans in this area (ZIP 48084)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1275517757 — is the standard way to identify this listing.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Dermatology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Troy, Michigan may find Unknown Individual in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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