St. Michael's Internal Medicine Physicians, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ST. MICHAEL'S INTERNAL MEDICINE PHYSICIANS, PLLC

Practice address

4448 Forestview Dr
West Bloomfield, MI 48322-4507

Phone

(248) 217-8405

NPI assigned

Aug 30, 2018

Last updated

Aug 30, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Revark Kammo, MDNPI 1326335241

Title

Owner/Physician

Phone

(248) 217-8405

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Revark David Kammo, M.D

  • Internal Medicine Physician
  • Pontiac, MI
  • NPI 1326335241
  Medicare reassignment Care Compare group NPD Authorized official
• Rita Kassab, DO

  • Internal Medicine Physician
  • Royal Oak, MI
  • NPI 1497384622
  Medicare reassignment Care Compare group NPD
• Sameer Ahmed, M.D

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1972725083
  Medicare reassignment NPD
• Jolene Kassab, FNP

  • Family Nurse Practitioner
  • West Bloomfield, MI
  • NPI 1508442880
  Medicare reassignment NPD
• Adrian Laith Michel, MD

  • Internal Medicine Physician
  • Southfield, MI
  • NPI 1851955777
  Medicare reassignment NPD
• Anmar Edward Sheet, MD

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1831415116
  Medicare reassignment NPD
• Rachel Helen Diegel

  • Physician Assistant
  • Royal Oak, MI
  • NPI 1396474383
  Medicare reassignment
• Lauren Marie Gasso, PA-C

  • Medical Physician Assistant
  • Pontiac, MI
  • NPI 1104263052
  Medicare reassignment
• Bernard G. Westbury, PA

  • Physician Assistant
  • Troy, MI
  • NPI 1336436716
  Medicare reassignment

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

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535587200000",
    "number": "1205318722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4448 FORESTVIEW DR",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483224507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4448 FORESTVIEW DR",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483224507",
            "telephone_number": "248-217-8405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MICHAEL'S INTERNAL MEDICINE PHYSICIANS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-30",
        "last_updated": "2018-08-30",
        "status": "A",
        "authorized_official_last_name": "KAMMO",
        "authorized_official_first_name": "REVARK",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "248-217-8405",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khalilla Spicer
• Lillie Ying Spilman
• Catherine Ann Spirko, LLMSW
• Seema Sridharan, PT
• Tiffany Marie St. Clair, M.D.
• Robert John Stachler, MD
• Tony Stankovski
• Courtney Lynne Stano, DPT, PT
• Linda Stanyk
• Donald Howell States II, BEHAVIOR TECHNICIAN

• Internal Medicine Physician in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.