Unknown Individual – Podiatrist, NPI 1376553644

Unknown Individual is a healthcare provider. based in Madison heights, Michigan. specializing in Podiatrist. They hold a License No. 5901000585 (MI). The NPI Number for Unknown Individual is 1376553644

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1376553644
Phone
(248) 542-7500
Address
28037 DEQUINDRE
Deactivation Date
4 December 2025

Doctor Profile

Medical School Name
KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
Secondary Phone
-
Graduation Year
1969 (57 years ago)
PAC ID
6103896626
Professional Enrollment ID
I20060428000025
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

  • Dequindre Road, Warren, Macomb County, Michigan, 48030, United States

    MADISON HEIGHTS, MI 48071

    Phone: (248) 542-7500

    Fax: (248) 542-7502

    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 48071)

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Provider's Procedures

Unknown Individual performs procedures in Podiatrist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PODIATRYMI73630X-ray of foot, minimum of 3 views5550

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1376553644 in the public NPI dataset.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Podiatrist. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Madison Heights, 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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