NPIMap

Organization Active NPI

Michigan Infusion and Licensed Healthcare

  • Physician Assistant
  • Plymouth, MI
National Provider Identifier
1164153367
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
MICHIGAN INFUSION AND LICENSED HEALTHCARE
Practice address
500 Ross St
Plymouth, MI 48170-2206
Phone
(734) 341-7767
NPI assigned
Jun 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

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

Authorized official

Name
Kelly L Long, PA-CNPI 1568623338
Title
Owner/Manager
Phone
(734) 341-7767

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

500 Ross St
Plymouth, MI 48170-2206

Mailing address

500 Ross St
Plymouth, MI 48170-2206
Phone (734) 341-7767

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1164153367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ROSS ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702206",
            "telephone_number": "734-341-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ROSS ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702206",
            "telephone_number": "734-341-7767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN INFUSION AND LICENSED HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-20",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "734-341-7767",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.