Active NPI
Dong Fang Zhao, M.D.
- General Practice Physician
- Grosse Pointe Park, MI
National Provider Identifier
1245895606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 4301505594
- Practice address
- 15001 Kercheval Ave PMB 502
Grosse Pointe Park, MI 48230-1361 - Phone
- (810) 322-7952
- NPI assigned
- May 1, 2019
- Reactivated
- Feb 13, 2020
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 4301505594 | MI | Primary |
Addresses
Primary practice location
15001 Kercheval Ave PMB 502
Grosse Pointe Park, MI 48230-1361
Mailing address
15001 Kercheval Ave PMB 502
Grosse Pointe Park, MI 48230-1361
Phone (810) 322-7952
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301505594 | MI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657584000000",
"number": "1245895606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15001 KERCHEVAL AVE PMB 502",
"city": "GROSSE POINTE PARK",
"state": "MI",
"postal_code": "482301361",
"telephone_number": "810-322-7952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15001 KERCHEVAL AVE PMB 502",
"city": "GROSSE POINTE PARK",
"state": "MI",
"postal_code": "482301361",
"telephone_number": "810-322-7952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZHAO",
"first_name": "DONG FANG",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-01",
"last_updated": "2022-07-12",
"certification_date": "2022-07-12",
"deactivation_date": "2019-12-16",
"reactivation_date": "2020-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "4301505594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grosse Pointe Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; 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.