Active NPI
Alex Kaddis, DO
- Neurology Physician
- Farmington Hills, MI
National Provider Identifier
1023866324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 5151016676
- Practice address
- 28050 Grand River Ave
Farmington Hills, MI 48336-5919 - Phone
- (947) 521-8399
- NPI assigned
- May 10, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 5151016676 | MI | Primary |
Addresses
Primary practice location
28050 Grand River Ave
Farmington Hills, MI 48336-5919
Mailing address
28050 Grand River Ave
Farmington Hills, MI 48336-5919
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240530003633 | MI | Order and Referring Only - Neurology | 6103268594 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715299200000",
"number": "1023866324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28050 GRAND RIVER AVE",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483365919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28050 GRAND RIVER AVE",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483365919",
"telephone_number": "947-521-8399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KADDIS",
"first_name": "ALEX",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-10",
"last_updated": "2024-05-10",
"certification_date": "2024-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MI",
"license": "5151016676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.