University Physician Group

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

4301054761 Issued in MI

Legal business name

UNIVERSITY PHYSICIAN GROUP

Practice address

26400 W 12 Mile Rd
Suite 60
Southfield, MI 48034-1774

Phone

(248) 594-6702

Fax

(248) 594-6738

NPI assigned

Jan 27, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Jeffery P Kohlitz

Title

Chief Financial Officer

Phone

(248) 581-5930

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wayne State University Physician Group Doing business as

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

{
    "created_epoch": "1453852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1114384757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E. MAPLE RD.",
            "address_2": "SUITE 400-CREDENTIALING",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831138",
            "telephone_number": "248-581-5973",
            "fax_number": "248-581-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26400 W 12 MILE RD",
            "address_2": "SUITE 60",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341774",
            "telephone_number": "248-594-6702",
            "fax_number": "248-594-6738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-27",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "KOHLITZ",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "248-581-5930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MI",
            "license": "4301054761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NGS",
            "identifier": "5717980008",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne State University Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Southfield, MI
• Providers in Southfield, MI by specialty
• Eyewear Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; 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.