Active NPI
Utibe Effiong, MBBCH
- Internal Medicine Physician
- Mt Pleasant, MI
National Provider Identifier
1104210582
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Dec 18, 2025.
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 2022-00615
- Practice address
- 4851 E Pickard St Ste 1760
Mt Pleasant, MI 48858 - Phone
- (989) 775-1610
- NPI assigned
- Mar 24, 2015
- Last updated
- Jul 27, 2023
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Internal Medicine Physician | 207R00000X | 4301108140 | MI | |
| Internal Medicine Physician | 207R00000X | 2022-00615 | NC | Primary |
Addresses
Primary practice location
4851 E Pickard St Ste 1760
Mt Pleasant, MI 48858
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Other practice location 1
4105 Matthews Mint Hill Rd
Matthews, NC 28105-3633
Phone (704) 316-3095
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301108140 | MI | MD | Internal Medicine Physician |
| 2022-00615 | NC | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1104210582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60447",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4851 E PICKARD ST STE 1760",
"city": "MT PLEASANT",
"state": "MI",
"postal_code": "48858",
"telephone_number": "989-775-1610"
}
],
"practiceLocations": [
{
"address_1": "4105 Matthews Mint Hill Rd",
"address_purpose": "LOCATION",
"city": "Matthews",
"state": "NC",
"postal_code": "281053633",
"country_code": "US",
"telephone_number": "704-316-3095",
"fax_number": "704-316-3096",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EFFIONG",
"first_name": "UTIBE",
"credential": "MBBCH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-03-24",
"last_updated": "2023-07-27",
"certification_date": "2023-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301108140",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NC",
"license": "2022-00615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Pleasant, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.