Unknown Individual – General Practice Physician, NPI 1790896900

Unknown Individual is a healthcare provider. based in Livonia, Michigan. specializing in General Practice Physician. They hold a License No. 5101004272 (MI). The NPI Number for Unknown Individual is 1790896900

Main info

Organization
Inactive
69 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1790896900
Phone
(248) 442-4901
Address
18306 MIDDLEBELT RD
Deactivation Date
7 January 2021

Doctor Profile

Medical School Name
MIDWESTERN UNIVERSITY, CHICAGO COLLEGE OF OSTEOPATHIC MED
Secondary Phone
-
Graduation Year
1957 (69 years ago)
PAC ID
6608945480
Professional Enrollment ID
I20080520000332
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

  • Middlebelt Road, Livonia, Wayne County, Michigan, 48154, United States

    LIVONIA, MI 481525007

    Phone: (248) 442-4901

    Fax: (248) 477-8356

    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 48152)

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Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1790896900 when you need to reference Unknown Individual in forms, claims, or directories.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects General Practice Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Livonia, Michigan because that is what the record indicates for Unknown Individual.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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