Unknown Individual – Cardiovascular Disease Physician, NPI 1902855166

Unknown Individual is a healthcare provider. based in St clair shores, Michigan. specializing in Cardiovascular Disease Physician. They hold a License No. 43010409892 (MI). The NPI Number for Unknown Individual is 1902855166

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1902855166
Phone
(586) 498-0440
Address
24211 LITTLE MACK AVE
Deactivation Date
7 June 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

  • 24211, Little Mack Avenue, Saint Clair Shores, Macomb County, Michigan, 48080, United States

    ST CLAIR SHORES, MI 480801190

    Phone: (586) 498-0440

    Fax: (586) 498-0401

    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 48080)

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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 1902855166 for Unknown Individual, then check state licensing separately.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Cardiovascular Disease Physician in this dataset. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to St Clair Shores, Michigan in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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