Unknown Individual – Nurse Practitioner, NPI 1679608350

Unknown Individual is a healthcare provider. based in Kalamazoo, Michigan. specializing in Nurse Practitioner. They hold a License No. 4704089381 (MI). The NPI Number for Unknown Individual is 1679608350

Main info

Organization
Inactive
49 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1679608350
Phone
(269) 381-3700
Address
610 SOUTH BURDICK ST
Deactivation Date
21 June 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9897258124
Graduation Year
1977 (49 years ago)
PAC ID
0143290320
Group Practice PAC ID
2365338225
Professional Enrollment ID
I20040727000253
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 610 SOUTH BURDICK ST

    KALAMAZOO, MI 49007

    Phone: (269) 381-3700

    Fax: (269) 381-3810

    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 49007)

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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: 2365338225View full group profile
NameSpecialtyState
Physician AssistantMI
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 1679608350 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 type of care does Unknown Individual provide?
Unknown Individual's profile centers on Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Kalamazoo, Michigan?
For routing, start with Kalamazoo, Michigan for Unknown Individual, then verify phone and hours locally.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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