Unknown Individual – Medical Physician Assistant, NPI 1164490207

Unknown Individual is a healthcare provider. based in Kalamazoo, Michigan. specializing in Medical Physician Assistant. They hold a License No. 5601001001 (MI). The NPI Number for Unknown Individual is 1164490207

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1164490207
Phone
(269) 381-7136
Address
1820 SHAFFER ST
Deactivation Date
1 May 2024
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

  • 1820, Shaffer Street, Eastwood, Kalamazoo Charter Township, Kalamazoo County, Michigan, 49048, United States

    KALAMAZOO, MI 490481604

    Phone: (269) 381-7136

    Fax: (269) 381-6665

    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 49048)

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Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1164490207 is assigned to Unknown Individual under the national enumeration system.
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 Medical Physician Assistant for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Kalamazoo, Michigan for Unknown Individual; expand the address list for detail.
What if Kalamazoo, Michigan seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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