Unknown Individual – Diagnostic Radiology Physician, NPI 1457349334

Unknown Individual is a healthcare provider. based in Ann arbor, Michigan. specializing in Diagnostic Radiology Physician. They hold a License No. 4301112025 (MI). The NPI Number for Unknown Individual is 1457349334

Main info

Organization
Inactive
39 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1457349334
Phone
(734) 936-2047
Address
3621 S STATE ST
Deactivation Date
19 July 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1987 (39 years ago)
PAC ID
8820085475
Group Practice PAC ID
3779496856
Professional Enrollment ID
I20171107000118
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience37
Completeness75
Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • South State Street, Ann Arbor, Washtenaw County, Michigan, 48108-1774, United States

    700 KMS PLACE

    ANN ARBOR, MI 48108

    Phone: (734) 936-2047

    Type: Mailing

  • Mott Children's Hospital and Von Voigtlander Women's Hospital, 1500, East Medical Center Drive, Ann Arbor, Washtenaw County, Michigan, 48109, United States

    B1 FLOOR UNIVERSITY HOSPITAL RECP C

    ANN ARBOR, MI 481095030

    Phone: (734) 936-4500

    Type: Location

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 48108)

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Provider's Procedures

Unknown Individual performs procedures in Diagnostic Radiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYMI71010X-ray of chest, 1 view, front124115
DIAGNOSTIC RADIOLOGYMI73630X-ray of foot, minimum of 3 views1212

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: 3779496856View full group profile
NameSpecialtyState
DR. JAMI ANN ROTHE KINNUCAN (M.D.)
G A S T R O E N T E R O L O G YFL
JOHN JOSEPH DANKO (DO)
Physical Medicine And RehabilitationMI
MEGHAN HORN (M.D.)
A N E S T H E S I O L O G YMI
AJAY BHASIN (MD)
Internal Medicine, Pediatric MedicineIL
WILMA ANNE MACKENZIE (AGACNP-BC)
-MI
ELIZABETH ANNE WALTERS (PA-C)
Physician AssistantMI

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1457349334 for Unknown Individual.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Ann Arbor, Michigan. Check all listed addresses for suites or satellite offices.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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