UNIVERSITY PHYSICIAN GROUP (NPI# 1275572075) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275572075 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY PHYSICIAN GROUP |
| Other Organization Name | WAYNE STATE UNIVERSITY PHYSICIAN GROUP |
| Practice Address |
4201 Saint Antoine St Suite 5g Detroit MI 48201-2153 |
| Mailing Address |
1560 E. Maple Rd. Suite 400-credentialing Dept. Troy MI 48083-1138 |
| Practice Telephone | 3137454095 |
| Practice Fax Number | 3135778555 |
| Mailing Telephone | 2485815973 |
| Mailing Fax Number | 2485815640 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2016-10-26 |
| Authorized Official Name | MR. JEFFERY P KOHLITZ (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 2485815930 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MEDICARE GROUP # - DDS | 0P32160 | 01 |
| Other Name | Type Code |
|---|---|
| Wayne State University Physician Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336492354 | University Physician Group | Physical Therapist | 44000 W 12 Mile Rd Ste 205, Wsupg Pm&r Oakwood, Novi, MI 48377-2647 | 2012-10-16 |
| 1457390254 | University Physician Group | Clinical Neuropsychologist | 4201 Saint Antoine St., Suite 8d, Detroit, MI 48201 | 2006-06-06 |
| 1447299797 | University Physician Group | Transplant Surgery | 4201 St. Antoine St., Detroit, MI 48201 | 2006-06-05 |
| 1114384757 | University Physician Group | Eyewear Supplier (Equipment, not the service) | 26400 W 12 Mile Rd, Suite 60, Southfield, MI 48034-1774 | 2016-01-27 |
| 1619380946 | University Physician Group | Pharmacist | 1560 E Maple Rd, Suite 400, Troy, MI 48083-1138 | 2014-06-04 |
| 1215379938 | University Physician Group | Eyewear Supplier (Equipment, not the service) | 1455 S Lapeer Rd, Suite 110, Lake Orion, MI 48360-1468 | 2013-07-23 |
| 1851630206 | University Physician Group | Occupational Therapist | 18100 Oakwood Blvd, Suite 300, Dearborn, MI 48124-4085 | 2013-02-05 |
| 1992044598 | University Physician Group | Prosthetic/Orthotic Supplier | 18100 Oakwood Blvd, Suite 300, Dearborn, MI 48124-4085 | 2013-02-04 |
| 1134492465 | University Physician Group | Eyewear Supplier (Equipment, not the service) | 4700 Schaefer Rd, Suite 260, Dearborn, MI 48126-3698 | 2012-02-16 |
| 1336417146 | University Physician Group | Speech-Language Pathologist | 4100 John R St, Karmanos Cancer Center-wertz Clinic, Detroit, MI 48201-2013 | 2011-12-07 |
| Street Address |
4201 SAINT ANTOINE ST SUITE 5G |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-2153 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760477871 | John Mckay Perkowski | Nurse Anesthetist, Certified Registered | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2005-09-14 |
| 1013517028 | Madappulli Arachchige Wickrama | Student in an Organized Health Care Education/Training Program | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-10-28 |
| 1134731466 | Helda Bacall | Nurse Practitioner | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-08-18 |
| 1568088680 | Michelle De Varennes | Physician Assistant | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-24 |
| 1235754144 | Saren Yeranosian | Pharmacist | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-16 |
| 1083239230 | Jacqueline Ferraro-jaworski | Pharmacist | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-13 |
| 1770107617 | Zamaan Sayeed Sohel | Student in an Organized Health Care Education/Training Program | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-06 |
| 1881218790 | Erin Marie Dinnell | Nurse Practitioner | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-06-05 |
| 1487276721 | Andrew R Kumar | Student in an Organized Health Care Education/Training Program | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-05-09 |
| 1598386005 | Kayla Richelle Robinson | Student in an Organized Health Care Education/Training Program | 4201 Saint Antoine St, Detroit, MI 48201-2153 | 2020-05-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1730707720 | Amr Hassan Abdelghaffar Omar | Pediatrics | 3901 Beaubien St Room 3t72, Children's Hospital of Michigan, Detroit, MI 48201 | 2020-07-07 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
| 1477176576 | Jaudat Fatima Masood | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street, University Health Center - 8c, Detroit, MI 48201 | 2020-05-22 |
| 1205459419 | Amit Kumar Dahiya | Student in an Organized Health Care Education/Training Program | 11201 St. Antoine, Room 2e Uhc, Detroit, MI 48201 | 2020-05-21 |
| 1851914188 | Asra Nausheen Shaik | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine St, Room 2e-uhc, Detroit, MI 48201 | 2020-05-21 |
| 1568085751 | Camille Olechowski | Student in an Organized Health Care Education/Training Program | 3901 Chrysler Dr. Detroit Medical Center, Room 5-a 538.1, Detroit, MI 48201 | 2020-05-21 |
| Find all providers in zip 48201 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730286543 | Felicia Dolores Wilson | Dentist | 3031 West Grand Blvd, Suite 360, Detroit, MI 48202 | 2006-09-20 |
| 1508466350 | Shriya Kulkarni | Dentist | 2700 Martin Luther King Jr Blvd, Detroit, MI 48208-2576 | 2020-10-30 |
| 1891222816 | Midhat Asfar | Dentist | 2700 Martin Luther King Jr Blvd, Detroit, MI 48208-2576 | 2017-05-22 |
| 1063537462 | University Otolaryngology | Dentist | 4201 Saint Antoine St, Suite 5g, Detroit, MI 48201-2153 | 2007-03-21 |
| 1427149863 | Darnell Kaigler Sr. | Dentist | 2671 W Grand Blvd, Detroit, MI 48208-1203 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083247803 | Neil L Matthews Dds PC | Dentist | 305 Barclay Cir Ste 1004, Rochester Hills, MI 48307-4572 | 2020-02-20 |
| 1336672831 | Jennifer Moeller | Dentist | 31410 Northwestern Hwy Ste E, Farmington Hills, MI 48334-2563 | 2017-04-11 |
| 1780040998 | Minaal Verma | Dentist | 41980 Manor Park Dr, Apt 122, Novi, MI 48375-2775 | 2016-01-05 |
| 1750638995 | David Lawrence Aitken | Dentist | 2021 Timber Point Dr Se, Ada, MI 49301-8323 | 2012-08-07 |
| 1184987075 | Yasser Alali | Dentist | 430 North Telegraph Road, Dearborn, MI 48128 | 2012-06-17 |
| 1013216639 | Prosthetic and Implants Dentistry PC | Dentist | 1206 S Washington Ave, Royal Oak, MI 48067-3222 | 2011-03-22 |
| 1710130174 | Andrew Koran IIi | Dentist | 7346 Park Lake Dr, Dexter, MI 48130-9616 | 2008-10-29 |
| 1225203714 | William H Roedema | Dentist | 3739 Basswood Dr Sw, Grandville, MI 49418-2003 | 2008-04-25 |
| 1679747455 | Michael P. Girskis | Dentist | 37667 Pembroke Ave, Livonia, MI 48152 | 2008-04-14 |
| 1417121294 | Stephen J. Riedy | Dentist | 31544 Schoolcraft Rd, Livonia, MI 48150-1805 | 2008-04-14 |
| Find all providers with the same taxonomy | ||||
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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.