Active NPI
Izabela Dziedzic
- Dermatology Physician
- Dearborn, MI
National Provider Identifier
1184463069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 5151016625APP24
- Practice address
- 18101 Oakwood Blvd
Dearborn, MI 48124-4089 - Phone
- (313) 593-7000
- NPI assigned
- May 21, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 5151016625APP24 | MI | Primary |
Addresses
Primary practice location
18101 Oakwood Blvd
Dearborn, MI 48124-4089
Mailing address
18101 Oakwood Blvd
Dearborn, MI 48124-4089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240529002599 | MI | Order and Referring Only - Dermatology | 0941642490 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5151016625APP24 | MI | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716249600000",
"number": "1184463069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18101 OAKWOOD BLVD",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481244089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18101 OAKWOOD BLVD",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481244089",
"telephone_number": "313-593-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DZIEDZIC",
"first_name": "IZABELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-21",
"last_updated": "2024-05-21",
"certification_date": "2024-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MI",
"license": "5151016625APP24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.