Individual provider Active NPI

Michael Maksimowski, M.D.

  • Psychiatry Physician
  • Detroit, MI
National Provider Identifier
1194168005
Registry record updated Aug 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301114125 Issued in MI
Practice address
4646 John R St
Detroit, MI 48201
Phone
(313) 576-1000
Fax
(313) 966-1195
NPI assigned
Apr 10, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychosomatic Medicine Physician 2084P0015X 4301114125 MI
Psychiatry Physician 2084P0800X 4301114125 MI Primary

Addresses

Primary practice location

4646 John R St
Detroit, MI 48201

Mailing address

4646 John R St RM B2340
Detroit, MI 48201-1916
Phone (313) 576-1000

Other practice location 1

2500 MetroHealth Dr
Cleveland, OH 44109-1998
Phone (216) 778-4486

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301114125MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System Current Accepting new patients

Locations

2500 Metrohealth Dr
Cleveland, OH 44109
Phone (216) 778-2348

Interoperability endpoints

  • Direct secure messaging: mmaksimowski55061@direct.metrohealth.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534982400000",
    "number": "1194168005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 JOHN R ST RM B2340",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011916",
            "telephone_number": "313-576-1000",
            "fax_number": "313-966-1195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-576-1000",
            "fax_number": "313-966-1195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 MetroHealth Dr",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441091998",
            "country_code": "US",
            "telephone_number": "216-778-4486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAKSIMOWSKI",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-10",
        "last_updated": "2018-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "MI",
            "license": "4301114125",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301114125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.