Individual provider Active NPI

Alaa K Hermiz, GENERAL DENTIST

  • Dentist
  • Oak Park, MI
National Provider Identifier
1013060375
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901018305 Issued in MI
Practice address
10460 W 9 Mile Rd
Ste #a
Oak Park, MI 48237
Phone
(248) 548-2210
Fax
(248) 548-1769
NPI assigned
Jan 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901018305 MI Primary

Addresses

Primary practice location

10460 W 9 Mile Rd
Ste #a
Oak Park, MI 48237

Mailing address

10460 W 9 Mile Rd
Ste #a
Oak Park, MI 48237
Phone (248) 548-2210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160104001136 MI Order and Referring Only - DentistPractitioner - Dentist 4688976970

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901018305MIMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013060375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10460 W 9 MILE RD",
            "address_2": "STE #A",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "48237",
            "telephone_number": "248-548-2210",
            "fax_number": "248-548-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10460 W 9 MILE RD",
            "address_2": "STE #A",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "48237",
            "telephone_number": "248-548-2210",
            "fax_number": "248-548-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERMIZ",
        "first_name": "ALAA",
        "middle_name": "K",
        "credential": "GENERAL DENTIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901018305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, MI

Sources for this page

Verify at the official NPI Registry.