INNOVATIVE HEALTH GROUP (NPI# 1912442104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912442104 |
| Entity Type | Organization |
| Organization Name | INNOVATIVE HEALTH GROUP |
| Practice Address |
24371 W 10 Mile Rd Southfield MI 48033-2929 |
| Mailing Address |
Po Box 3190 Southfield MI 48037-3190 |
| Practice Telephone | 2488186143 |
| Enumeration Date | 2016-12-27 |
| Last Update Date | 2016-12-27 |
| Authorized Official Name | DR. RICARDO BORREGO (OWNER) |
| Authorized Official Telephone | 2488186143 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | INNOVATIVE HEALTH GROUP LLC | 1280 Sw 36th Ave. Ste 100, Pompano Beach, FL 33069 |
| Connecticut Business Registrations | Innovative Health Group LLC | 1280 Sw 36th Ave., Ste. 208, Pompano Beach, FL 33069 |
| Virginia Business Entities | INNOVATIVE HEALTH GROUP LLC | 1280 Sw 36th Ave, Ste 100, Pompano Beach, Florida 33059 |
| Colorado Business Entities | Innovative Health Group LLC | 1280 Sw 36th Ave, Suite 100, Pampano Beach, FL 33069 |
| Street Address |
24371 W 10 MILE RD |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48033-2929 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043200132 | Edward Y Mishal | Internal Medicine | 24371 W 10 Mile Rd, Southfield, MI 48034-2929 | 2005-10-28 |
| 1477976686 | Vital Community Care P C | Clinic/Center | 24371 W 10 Mile Rd, Southfield, MI 48033-2929 | 2014-01-23 |
| 1669730008 | Casey Darrah | General Practice | 24371 W 10 Mile Rd, Southfield, MI 48033-2929 | 2012-04-23 |
| 1497843643 | Todd Michael Corden | Physician Assistant | 24371 W 10 Mile Rd, Southfield, MI 48034-2929 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013531243 | Kenicka Harper | Case Manager/Care Coordinator | 2270 W Nine Mile Rd, Detroit, MI 48033 | 2020-06-03 |
| 1154955292 | Judy C Staples | Registered Nurse | 23800 West 10 Mile Road, Ste. 110, Southfield, MI 48033 | 2020-02-27 |
| 1578193827 | Axel Lee Gruenberg | Peer Specialist | 221790 West 9 Mile, Southfield, MI 48033 | 2020-01-24 |
| 1851958706 | William Beaumont Hospital | Clinic/Center | 26901 Beaumont Blvd., D - 5, Community Health, Southfield, MI 48033 | 2019-05-28 |
| 1396302857 | William Beaumont Hospital | Clinic/Center | Beaumont Service Center, 26901 Beaumont Blvd, Community Health, D - 5, Southfield, MI 48033 | 2019-05-21 |
| 1700442597 | Botsford General Hospital | Clinic/Center | 26901 Beaumont Blvd, Beaumont Service Center, Community Health, D - 5, Southfield, MI 48033 | 2019-05-16 |
| 1558862433 | Oakwood Accountable Care Organization, LLC | Preferred Provider Organization | 26901 Beaumont Blvd., Southfield, MI 48033 | 2018-02-26 |
| 1891228904 | Brandi Becker-wright | Social Worker | 25200 Telegraph Rd Ste 100, Southfield, MI 48033 | 2017-04-05 |
| 1003362252 | Mark Kline | Registered Nurse | 22170 W Nine Mile Rd, Southfield, MI 48033 | 2016-08-28 |
| 1033534797 | Jessica Savageau | Social Worker | 22170 W 9 Mile, Southfield, MI 48033 | 2014-03-04 |
| Find all providers in zip 48033 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144865411 | Yasmeen Global Beauty Group | Specialist | 21701 W 11 Mile Rd Ste 7, Southfield, MI 48076-3713 | 2019-11-11 |
| 1124685789 | Grooming Arts Lounge and Gallery | Specialist | 19520 Dorset St, Southfield, MI 48075-7112 | 2019-05-20 |
| 1376929562 | Michigan Home Physician Service, Pllc | Specialist | 26645 W 12 Mile Road, Suite 109, Southfield, MI 48034-7811 | 2015-08-11 |
| 1366831273 | Destiny Peterson | Specialist | 21415 Civic Center Dr Ste 209, Southfield, MI 48076-3943 | 2015-01-15 |
| 1831517036 | Naomi Darden | Specialist | 25711 Southfield Rd, 206, Southfield, MI 48075-1875 | 2014-04-03 |
| 1295039899 | Wellness Center of Michigan LLC | Specialist | 17336 W 12 Mile Rd Ste 102, Southfield, MI 48076-2113 | 2010-12-23 |
| 1710155627 | Milton Foss Simmons | Specialist | 18658 George Washington Dr, Southfield, MI 48075-2552 | 2008-02-13 |
| 1770632945 | Flora Ann Dean | Specialist | 17330 Northland Park Court, Suite 201, Southfield, MI 48075-4318 | 2007-01-09 |
| 1245324789 | Cristina Torres | Specialist | 24500 Northwestern Highway, Southfield, MI 48075 | 2006-10-02 |
| 1689766065 | Dawit Teklehaimanot | Specialist | Physical Medicine and Rehabilation and Pain Consultant, 17117 West Nine Mile Road Suite 1331, Southfield, MI 48075 | 2006-09-29 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48033 |
Please comment or provide details below to improve the information on INNOVATIVE HEALTH GROUP.
| 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.