Individual provider Active NPI

Mehmet Ismailoglu, MD

  • Student in an Organized Health Care Education/Training Program
  • Port Huron, MI
National Provider Identifier
1124861703
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
4351053169 Issued in MI
Practice address
1216 Richardson St
Port Huron, MI 48060-3549
Phone
(810) 985-2640
Fax
(810) 962-8294
NPI assigned
Jun 13, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4351053169 MI Primary

Addresses

Primary practice location

1216 Richardson St
Port Huron, MI 48060-3549

Mailing address

1216 Richardson St
Port Huron, MI 48060-3549
Phone (810) 985-2640

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240624000741 MI Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 2860935475

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4351053169MIMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1124861703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 RICHARDSON ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603549",
            "telephone_number": "810-985-2640",
            "fax_number": "810-962-8294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 RICHARDSON ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603549",
            "telephone_number": "810-985-2640",
            "fax_number": "810-962-8294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISMAILOGLU",
        "first_name": "MEHMET",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4351053169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.