UNIVERSITY PHYSICIAN GROUP (NPI# 1336417146) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336417146 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY PHYSICIAN GROUP |
| Other Organization Name | WAYNE STATE UNIVERSITY PHYSICIAN GROUP |
| Practice Address |
4100 John R St Karmanos Cancer Center-wertz Clinic Detroit MI 48201-2013 |
| Mailing Address |
1560 E. Maple Rd. Suite 400-credentialing Dept Troy MI 48083-1138 |
| Practice Telephone | 8005276266 |
| Practice Fax Number | 3135768381 |
| Mailing Telephone | 2485815973 |
| Mailing Fax Number | 2485815640 |
| Enumeration Date | 2011-12-07 |
| 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 | 235Z00000X | Speech-Language Pathologist | 4301038094 | MI | Speech, Language and Hearing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | CLIA WAIVER | 23D1065430 | 01 |
| MI | MEDICARE GROUP # | 0P30630 | 01 |
| MI | BCBSM GROUP NUMBER | 0H27520 | 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 |
| 1740590678 | University Physician Group | Eyewear Supplier (Equipment, not the service) | 4700 Schaefer Rd, Suite 165, Dearborn, MI 48126-3698 | 2010-10-13 |
| Street Address |
4100 JOHN R ST KARMANOS CANCER CENTER-WERTZ CLINIC |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-2013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518966316 | Cynthia Hilda Marsack | Nurse Practitioner | 4100 John R St, Karmanos Cancer Ctr Midlevels, Detroit, MI 48201-2013 | 2005-07-14 |
| 1467062950 | Amy Josephine Skotzke | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2020-08-09 |
| 1700421294 | Nicole Gonzalez | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2019-11-08 |
| 1881237485 | Joseph Charles Ellul | Internal Medicine | 4100 John R St, Detroit, MI 48201-2013 | 2019-10-26 |
| 1841840113 | Thoracic Surgical Services, PC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4100 John R St, Detroit, MI 48201-2013 | 2019-09-18 |
| 1568016244 | Ellen Wong Dillard | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2019-07-30 |
| 1700340924 | Rita J Dibiase | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2019-01-23 |
| 1336634468 | Linsday Anne Cleveland | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2018-07-01 |
| 1407347214 | Diana Rudnev | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2018-05-29 |
| 1912408915 | Yaukpala Ina Gofan | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2018-02-24 |
| 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 | 235Z00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Speech-Language Pathologist |
| The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing. |
| Notes: "Scope of Practice in Speech-Language Pathology", American Speech-Language-Hearing Association, 2013. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205381365 | Frederick Turner | Speech-Language Pathologist | 2400 W Mcnichols Rd, Detroit, MI 48221-3129 | 2016-08-18 |
| 1194199794 | Need To Talk, LLC | Speech-Language Pathologist | 1420 Washington Blvd, Detroit, MI 48226-1718 | 2015-11-19 |
| 1730514514 | Matthew G Berry | Speech-Language Pathologist | 542 W Grand Blvd, Detroit, MI 48216-1439 | 2013-09-11 |
| 1801154943 | Peter Rabbit Day Care Center Inc | Speech-Language Pathologist | 5901 Cadieux Rd, Detroit, MI 48224-2003 | 2012-04-26 |
| 1225326366 | Katie Marie Kearns | Speech-Language Pathologist | 5447 Woodward Avenue, Detroit, MI 48202-4099 | 2011-07-11 |
| 1326331877 | Lisa Michelle Moreasun | Speech-Language Pathologist | 10310 Mackenzie St, Detroit, MI 48204-3009 | 2011-05-17 |
| 1962634865 | Patricia A. Pace | Speech-Language Pathologist | 4627 Lumley St, Upper, Detroit, MI 48210-2199 | 2009-08-12 |
| 1043441660 | Aaron Delaine Hardy-smith | Speech-Language Pathologist | 16811 Rosemont Ave, Detroit, MI 48219-4117 | 2009-07-30 |
| 1477793651 | Cheryl Lynette Lang | Speech-Language Pathologist | 1365 Bagley St, Detroit, MI 48226-1004 | 2009-02-27 |
| 1639243801 | Ruth Remus | Speech-Language Pathologist | 14574 Warwick St, Detroit, MI 48223-2247 | 2006-11-20 |
| Find all providers in DETROIT | ||||
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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.