UNIVERSITY PHYSICIAN GROUP (NPI# 1346289147) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346289147 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY PHYSICIAN GROUP |
| Other Organization Name | WAYNE STATE UNIVERSITY PHYSICIAN GROUP |
| Practice Address |
4100 John R St Detroit MI 48201-2013 |
| Mailing Address |
1560 E Maple Rd Suite 400-credentialing Dept Troy MI 48083-1138 |
| Practice Telephone | 3137454525 |
| Practice Fax Number | 3135768381 |
| 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 | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | CLIA COMPLIANCE DERM | 23D0650703 | 01 |
| MI | CLIA MICROSCOPY | 23D1096986 | 01 |
| MI | CLIA - PPM (MODERATE COMPLEXITY) | 23D0701622 | 01 |
| MI | CLIA REGISTRATION (HIGH COMPLEXITY) | 23D2054540 | 01 |
| MI | CLIA COMPLIANCE DERM | 23D0685178 | 01 |
| MI | BCBSM GROUP NUMBER | 0H22830 | 01 |
| MI | MEDICARE GROUP # - NP | 0P32180 | 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 |
4100 JOHN R ST |
| 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 |
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| 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 | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629616511 | Nursing Practice Corporation | Nurse Practitioner | 1550 Taylor St, Detroit, MI 48206-2081 | 2019-12-11 |
| 1578026076 | Julia Christine Zaddock | Nurse Practitioner | 12800 Toronto St., Detroit, MI 48217 | 2019-04-11 |
| 1629552112 | Katelyn E. Hamann | Nurse Practitioner | Children's Hosptial of Mi, 3901 Beaubien - 2nd Fl - Carl's Bldg, Detroit, MI 48201-2119 | 2018-09-20 |
| 1750801023 | Amy Marie Bertha | Nurse Practitioner | New Center One/endocrinology/metabolism, 3031 W. Grand Blvd, Detroit, MI 48202 | 2017-06-27 |
| 1376077107 | Maryam Hakemi | Nurse Practitioner | 3990 John R. St., Harper University Hospital, Detroit, MI 48201 | 2017-04-19 |
| 1841748076 | Jennifer N. Watson | Nurse Practitioner | 3950 Beaubien - Ground Fl, Children's Hospital of Mi, Detroit, MI 48201-2153 | 2016-09-16 |
| 1891164323 | Cheryl Barratt | Nurse Practitioner | Children's Hospital of Mi - Er, 3901 Beaubien, Detroit, MI 48201 | 2015-09-15 |
| 1730556291 | Markita Marie Thompson | Nurse Practitioner | 277 Gratiot Ave Ste 100a8919, Detroit, MI 48226-2239 | 2015-08-31 |
| 1316372980 | Sarah Kironde | Nurse Practitioner | 7700 2nd Avenue, Detroit, MI 48202 | 2013-09-13 |
| 1679917322 | Arlanda Latrice Smith | Nurse Practitioner | 8904 Woodward Ave, Detroit, MI 48202-1821 | 2013-04-24 |
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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.