Jeffrey Edwin Middeldorf, D.O.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

5101012371 Issued in MI

Practice address

5700 E 11 Mile Road
Suite C
Warren, MI 48089

Phone

(586) 558-4482

Fax

(586) 558-8923

NPI assigned

Aug 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386633600000",
    "number": "1063528958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 WEST BIG BEAVER ROAD",
            "address_2": "SUITE 480",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844764",
            "telephone_number": "248-797-8324",
            "fax_number": "248-816-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 E 11 MILE ROAD",
            "address_2": "SUITE C",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48089",
            "telephone_number": "586-558-4482",
            "fax_number": "586-558-8923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDDELDORF",
        "first_name": "JEFFREY",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2013-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301003007",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "5101012371",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "2238841",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3742088",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "2555002114BX33",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michigan Surgery Specialists, P.C.
• Michigan Surgery Specialists, P.C.
• Michigan Surgery Specialists, P.C.
• Michigan Surgery Specialists, P.C.
• Michigan Tri-County Physical Therapy PLLC
• Midtown Dental
• Midtown Dental Center PC
• Midwest Family Diagnostics PLC
• Midwest Family Practices, PLC
• Midwest Home Care Services LLC

• All providers in Warren, MI
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2013; 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.