Unknown Individual – Geriatric Medicine (Internal Medicine) Physician, NPI 1790723815

Unknown Individual is a healthcare provider. based in Detroit, Michigan. specializing in Geriatric Medicine (Internal Medicine) Physician. They hold a License No. 4301044391 (MI). The NPI Number for Unknown Individual is 1790723815

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1790723815
Phone
(313) 745-1741
Address
4201 ST ANTOINE SUITE 5B
Deactivation Date
17 May 2023
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 4201 ST ANTOINE SUITE 5B

    DRH ROSA PARKS WELLNESS INSTITUTE FOR SR HEALTH

    DETROIT, MI 48201

    Phone: (313) 745-1741

    Fax: (313) 745-8165

    Type: Location

  • 1560, East Maple Road, Troy, Oakland County, Michigan, 48083, United States

    SUITE 400-CREDENTIALING

    TROY, MI 480831138

    Phone: (313) 745-1741

    Fax: (313) 745-8165

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $15.

Total Amount is formed as General ($15) + Research ($0) + Ownership ($0) = $15.

Last reported payment date: 2024-12-10 • Largest payer in this snapshot: PFIZER INC. ($15).

Total Amount

$15

General + Research + Ownership

Payments

1

Total payment records

General Amount

$15

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-10

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
PFIZER INC.$15
View all Open Payments →|Open Payments Risk Radar →

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.

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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 48201)

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Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1790723815.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Geriatric Medicine (Internal Medicine) Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Detroit, Michigan in our summary view.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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