Unknown Individual – Family Medicine Physician, NPI 1710913512

Unknown Individual is a healthcare provider. based in Stevensville, Michigan. specializing in Family Medicine Physician. They hold a License No. 4301032453 (MI). The NPI Number for Unknown Individual is 1710913512

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710913512
Phone
(269) 429-9644
Address
5515 CLEVELAND AVE
Deactivation Date
3 May 2023

Doctor Profile

Medical School Name
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2694296604
Graduation Year
1972 (54 years ago)
PAC ID
6507779881
Group Practice PAC ID
1658427042
Professional Enrollment ID
I20100717000158
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

Loading map...

Provider Addresses for Unknown Individual

  • Southwestern Medical Clinic, 5515, Cleveland Avenue, Stevensville, Lincoln Charter Township, Berrien County, Michigan, 49127, United States

    STEVENSVILLE, MI 491279670

    Phone: (269) 429-9644

    Fax: (269) 429-4002

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 49127)

Loading plans...

Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEMI90670Pneumococcal vaccine for injection into muscle1414

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: 1658427042View full group profile
NameSpecialtyState
-MI
Nurse PractitionerMI
Nurse PractitionerMI
-MI
-MI
Physician AssistantMI
-MI
Physician AssistantMI
Internal MedicineMI
O B S T E T R I C S/ G Y N E C O L O G YMI

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1710913512; it appears in the national provider directory.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Family Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Stevensville, Michigan for Unknown Individual; download NPPES for the complete set.
What if Stevensville, Michigan seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

Similar Providers

DR. BARBARA S CARLSON (M.D.)

Family Medicine Physician
3950, Hollywood Road, Royalton Township, Berrien County, Michigan, 49085, United States
NPI: 1710975529

DR. WILLIAM H WARD (MD)

Family Medicine Physician
5230 E Stop 11 Rd
NPI: 1689657785

DR. MILAD HELMY HANNA (M.D.)

Family Medicine Physician
5515 Cleveland Ave
NPI: 1982674347

PATRICK W HOLBERT (M.D.)

Family Medicine Physician
Southwestern Medical Clinic, 5515, Cleveland Avenue, Stevensville, Lincoln Charter Township, Berrien County, Michigan, 49127, United States
NPI: 1851320717

DONALD WOLFRAM (M.D.)

Family Medicine Physician
1007 Lincolnway
NPI: 1669499257

DR. TROY A THOMPSON (MD)

Family Medicine Physician
Southwestern Medical Clinic, 5515, Cleveland Avenue, Stevensville, Lincoln Charter Township, Berrien County, Michigan, 49127, United States
NPI: 1477573962
5515 Cleveland Ave Ste 5
NPI: 1366609547

DR. IAN ANDREW JACKSON (M.D.)

Family Medicine Physician
5515 CLEVELAND AVE
NPI: 1598084691

BRANDON ROBERT COLE (DO)

Family Medicine Physician
5515 CLEVELAND AVE STE 5
NPI: 1033522313