Unknown Individual – Surgery Physician, NPI 1104826031

Unknown Individual is a healthcare provider. based in Troy, Michigan. specializing in Surgery Physician. They hold a License No. 4301054892 (MI). The NPI Number for Unknown Individual is 1104826031

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104826031
Phone
Not provided
Address
130 TOWN CENTER DRIVE
Deactivation Date
2 December 2020
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

  • 130, Town Center Drive, Troy, Oakland County, Michigan, 48084, United States

    203

    TROY, MI 480841744

    Phone:

    Type: Mailing

  • Beaumont Hospital - Royal Oak, 3601, West 13 Mile Road, Royal Oak, Oakland County, Michigan, 48073, United States

    ROYAL OAK, MI 480736712

    Phone: (248) 551-3300

    Fax: (248) 551-3370

    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 48084)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1104826031 for Unknown Individual, then check state licensing separately.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Surgery Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Troy, Michigan as a primary anchor for Unknown Individual unless the record lists multiple sites.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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