Individual provider Active NPI

Dylan Cruz, MEDICAL STUDENT

  • Student in an Organized Health Care Education/Training Program
  • Shelby TWP, MI
National Provider Identifier
1003763467
Registry record updated Mar 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
54886 Deadwood LN
Shelby TWP, MI 48316-2332
Phone
(586) 306-8894
NPI assigned
Mar 13, 2026
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

54886 Deadwood LN
Shelby TWP, MI 48316-2332

Mailing address

54886 Deadwood LN
Shelby TWP, MI 48316-2332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773360000000",
    "number": "1003763467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54886 DEADWOOD LN",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483162332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54886 DEADWOOD LN",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483162332",
            "telephone_number": "586-306-8894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "DYLAN",
        "name_prefix": "Mr.",
        "credential": "MEDICAL STUDENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-03-13",
        "last_updated": "2026-03-13",
        "certification_date": "2026-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby TWP, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.