PROMEDICA CENTRAL PHYSICIANS LLC (NPI# 1083959522) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083959522 |
| Entity Type | Organization |
| Organization Name | PROMEDICA CENTRAL PHYSICIANS LLC |
| Other Organization Name | PROMEDICA CHILDREN'S SPECIALTIES |
| Practice Address |
730 N Macomb St Suite 300 Monroe MI 48162-2900 |
| Practice Telephone | 4192917010 |
| Practice Fax Number | 4194796917 |
| Mailing Telephone | 4192917010 |
| Mailing Fax Number | 4194796917 |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2019-07-18 |
| Authorized Official Name | KRISTIN KNUEVEN (CREDENTIALING SUPERVISOR) |
| Authorized Official Telephone | 5675851969 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0206X |
Pediatrics Specialization: Pediatric Gastroenterology |
MI | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| ProMedica Children's Specialties | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285168450 | Promedica Central Physicians LLC | Clinic/Center | 217 Golden Gate Plz, Maumee, OH 43537-2881 | 2017-04-14 |
| 1689072407 | Promedica Central Physicians LLC | Ophthalmology | 435 S Hawley St, Toledo, OH 43609-2344 | 2014-12-10 |
| 1043673700 | Promedica Central Physicians LLC | Clinic/Center | 6755 W Central Ave, Toledo, OH 43617-1109 | 2016-03-31 |
| 1255792024 | Promedica Central Physicians LLC | Clinic/Center | 6711 Airport Hwy, Holland, OH 43528-8104 | 2016-03-08 |
| 1730544511 | Promedica Central Physicians LLC | Clinic/Center | 5700 Monroe St, Sylvania, OH 43560-2767 | 2015-12-22 |
| 1316302359 | Promedica Central Physicians LLC | Clinic/Center | 25950 Dixie Hwy, Perrysburg, OH 43551-2983 | 2015-12-17 |
| 1568842813 | Promedica Central Physicians LLC | Clinic/Center | 3316 Navarre Ave, Suite F, Oregon, OH 43616-3314 | 2015-06-02 |
| 1962800672 | Promedica Central Physicians LLC | Ophthalmology | 3165 Navarre Ave, Oregon, OH 43616-4348 | 2014-12-11 |
| 1417355223 | Promedica Central Physicians LLC | Ophthalmology | 1180 N Monroe St, Monroe, MI 48162-3190 | 2014-12-10 |
| 1023416849 | Promedica Central Physicians LLC | Ophthalmology | 60 Ashwood Dr, Tiffin, OH 44883-1908 | 2014-12-10 |
| Street Address |
730 N MACOMB ST SUITE 300 |
| City | MONROE |
| State | MI |
| Zip Code | 48162-2900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710983812 | Ashwin H Shah | Urology | 730 N Macomb St, Ste 319, Monroe, MI 48162 | 2005-06-23 |
| 1366721011 | Promedica Northwest Ohio Cardiology Consultants, LLC | Internal Medicine | 730 N Macomb St, Suite 429, Monroe, MI 48162-2900 | 2011-08-12 |
| 1659676708 | Promedica Monroe Cardiology, Pllc | Internal Medicine | 730 N Macomb St, Suite 429, Monroe, MI 48162-2900 | 2011-01-21 |
| 1760632962 | Monroe Arthritis Clinic Pllc | Internal Medicine | 730 N Macomb St, Suite 320, Monroe, MI 48162-2900 | 2008-09-24 |
| 1104092337 | Michael J Charboneau Jr Do Pllc | Surgery | 730 N Macomb St, Suite 329, Monroe, MI 48162-2900 | 2008-05-07 |
| 1003091141 | Monroe Ear, Nose and Throat Associates, P.C. | Audiologist | 730 N Macomb St, Suite 320, Monroe, MI 48162-2900 | 2008-01-08 |
| 1467641951 | Usha R Tampi | Internal Medicine | 730 N Macomb St, Suite 229, Monroe, MI 48162-2900 | 2007-10-19 |
| 1407995822 | Ashwin H Shah Md PC | Urology | 730 N Macomb St, Suite 319, Monroe, MI 48162-2900 | 2007-02-05 |
| 1194893081 | Cardiology Consultants of Michigan & Ohio, P.C. | Specialist | 730 N Macomb St, Ste #429, Monroe, MI 48162-2900 | 2006-12-01 |
| 1386724987 | Lisa M Vick | Pharmacist | 730 N Macomb St, Monroe, MI 48162-2900 | 2006-10-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568016012 | Silke A Goudos | Nurse Practitioner | 730 N Macomb Street #200, Monroe, MI 48162 | 2019-08-01 |
| 1134781412 | Joshua Dwaine Lentz | Family Medicine | Promedica Monroe Regional Hospital, 650 Stewart Road, Monroe, MI 48162 | 2019-07-08 |
| 1740769702 | Carissa Pollock | Behavioral Analyst | 2086 S. Custer Rd., Monroe, MI 48162 | 2018-08-10 |
| 1710488440 | Stacy Michael Lucio | Nurse Practitioner | 901 N Macomb St Ste 109, Monroe, MI 48162 | 2018-02-27 |
| 1407239882 | Lisa Gilbert Peleman | Student in an Organized Health Care Education/Training Program | Promedica Monroe Regional Hospital Family Medicine Res, 650 Stewart Rd, Monroe, MI 48162 | 2015-07-03 |
| 1427430552 | Cheryl Fosgate | Counselor | 4350 N Monroe St, Monroe, MI 48162 | 2015-06-25 |
| 1538551460 | Convenient Mr PC | Dentist | 7500 N. Telegraph Rd., Monroe, MI 48162 | 2015-03-02 |
| 1659614022 | Mercy Memorial Hospital Corporation | Family Medicine | 650 Steward Road, Monroe, MI 48162 | 2013-04-03 |
| 1073872743 | Justin L Chamberlain | Surgery | 730 N Macomb St Ste 329, Monroe, MI 48162 | 2012-05-15 |
| 1639462674 | Toledo Clinic Incorporated | Durable Medical Equipment & Medical Supplies | 800 Stewart Road, Suite B, Monroe, MI 48162 | 2011-05-24 |
| Find all providers in zip 48162 | ||||
| Taxonomy Code | 2080P0206X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Gastroenterology |
| A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154854685 | Digestive Care of Lansing Plc | Pediatrics | 503 Mall Ct # 145, Lansing, MI 48912-5200 | 2017-04-11 |
| 1215037569 | Janice B Heikenen | Pediatrics | 6287 Lagoon Lane, Box 439, Mohawk, MI 49950 | 2006-09-25 |
| 1881603975 | Vasundhara Tolia | Pediatrics | 4304 Copper Cliff, Bloomfield Hills, MI 48302-1922 | 2006-08-07 |
| 1538194055 | Safwan Malas | Pediatrics | 1200 E Michigan Ave Ste 410, Lansing, MI 48912-1850 | 2006-07-12 |
| 1629048699 | Deborah L Cloney | Pediatrics | 35 Michigan Ne, Suite 4150, Grand Rapids, MI 49503 | 2006-01-24 |
| 1841791217 | Ashley Joanne Ross | Pediatrics | 601 John St Ste M-351, Kalamazoo, MI 49007-5358 | 2018-02-21 |
| 1083146906 | S Madani Md PC | Pediatrics | 4727 Saint Antoine St, Suite 402, Detroit, MI 48201-1461 | 2017-03-30 |
| 1497165153 | Salman S. Salman | Pediatrics | 3901 Beaubien, Detroit, MI 48201-2119 | 2014-05-04 |
| 1336405554 | Jennifer B Mitsuya | Pediatrics | 3535 W 13 Mile Rd Ste 707, Royal Oak, MI 48073 | 2012-04-02 |
| 1457665671 | Sanjay Kumar | Pediatrics | 22201 Moross Road, Suite 270, Pbii, Detroit, MI 48236 | 2010-07-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.