Unknown Individual – Urology Physician, NPI 1679561906

Unknown Individual is a healthcare provider. based in Ann arbor, Michigan. specializing in Urology Physician. They hold a License No. 4301405967 (MI). The NPI Number for Unknown Individual is 1679561906

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1679561906
Phone
(734) 647-5299
Address
3621 S STATE ST
Deactivation Date
13 October 2023

Doctor Profile

Medical School Name
WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2317399492
Graduation Year
1985 (41 years ago)
PAC ID
0345255352
Group Practice PAC ID
3779496856
Professional Enrollment ID
I20101007000676
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

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

    ANN ARBOR, MI 481081633

    Phone: (734) 647-5299

    Type: Mailing

  • 1301, Mercy Drive, Muskegon, Muskegon County, Michigan, 49444, United States

    MUSKEGON, MI 494441837

    Phone: (231) 739-9492

    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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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
G A S T R O E N T E R O L O G YFL
Physical Medicine And RehabilitationMI
A N E S T H E S I O L O G YMI
Internal Medicine, Pediatric MedicineIL
-MI
Physician AssistantMI

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1679561906 uniquely identifies Unknown Individual in U.S. healthcare data.
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 does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Urology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Ann Arbor, Michigan?
If you are local to Ann Arbor, Michigan, Unknown Individual may be relevant to your search.
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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