Unknown Individual – Surgery Physician, NPI 1114925914

Unknown Individual is a healthcare provider. based in Lansing, Michigan. specializing in Surgery Physician. They hold a License No. 4301034281 (MI). The NPI Number for Unknown Individual is 1114925914

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1114925914
Phone
(517) 483-4780
Address
405 W GREENLAWN AVE
Deactivation Date
19 July 2023
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

  • 405, West Greenlawn Avenue, Greencroft Park, Lansing, Ingham County, Michigan, 48910, United States

    SUITE 305

    LANSING, MI 489102898

    Phone: (517) 483-4780

    Fax: (517) 483-4862

    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 48910)

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Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1114925914.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What kind of provider is Unknown Individual?
The page reflects Surgery Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Lansing, Michigan for Unknown Individual based on available NPPES addresses.
What if Lansing, Michigan seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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