Active NPI
Nyles Mark Zdzieblowski
- Occupational Therapist
- Southfield, MI
National Provider Identifier
1154192094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 520103568
- Practice address
- 26715 Greenfield Rd
Southfield, MI 48076-4717 - Phone
- (248) 557-0050
- NPI assigned
- Jan 10, 2024
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 520103568 | MI | Primary |
Addresses
Primary practice location
26715 Greenfield Rd
Southfield, MI 48076-4717
Mailing address
765 S Grey Rd
Auburn Hills, MI 48326-3817
Phone (414) 315-2040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260410003299 | MI | Practitioner - Occupational Therapist in Private Practice | 1153896733 |
Care Compare profile
Medicare Care Compare- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2002
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
32715 Grand River Ave
Farmington Hills, MI 48336-3113
437 Black Cherry Way
Conway, SC 29526-2654
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 520103568 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704844800000",
"number": "1154192094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "765 S GREY RD",
"city": "AUBURN HILLS",
"state": "MI",
"postal_code": "483263817",
"telephone_number": "414-315-2040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26715 GREENFIELD RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480764717",
"telephone_number": "248-557-0050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZDZIEBLOWSKI",
"first_name": "NYLES",
"middle_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-10",
"last_updated": "2024-01-10",
"certification_date": "2024-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "520103568",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.