Active NPI
International Medical Clinic PLLC
- Neurology Physician
- Bloomfield, MI
National Provider Identifier
1306473418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- Legal business name
- INTERNATIONAL MEDICAL CLINIC PLLC
- Practice address
- 43902 Woodward Ave Ste 100
Bloomfield, MI 48302-5021 - Phone
- (248) 955-9949
- Fax
- (248) 928-2274
- NPI assigned
- Mar 26, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ramesh Madhavan, MD
- Title
- Ceo
- Phone
- (248) 955-9949
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | Primary |
Addresses
Primary practice location
43902 Woodward Ave Ste 100
Bloomfield, MI 48302-5021
Mailing address
43902 Woodward Ave Ste 100
Bloomfield Hills, MI 48302-5021
Phone (248) 955-9949
Other practice location 1
6255 Inkster Rd Ste 101
Garden City, MI 48135-2538
Phone (248) 955-9949
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200818002534 | MI | Part B Supplier - Clinic/Group Practice | 0941626188 |
Receives reassigned benefits from 9 practitioners Practice locations: Port Huron, MI; Garden City, MI; Bloomfield Hills, MI |
National Provider Directory
National Provider DirectoryLocations
26100 American Dr
Ste 200
Southfield, MI 48034
Phone (248) 331-2723
Practitioners & affiliated clinicians
Practitioners 10
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Neurology Physician
- Pontiac, MI
- NPI 1528212768
MI, Neurology
-
- Internal Medicine Physician
- Southfield, MI
- NPI 1568849560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585180800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1704931200000",
"number": "1306473418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43902 WOODWARD AVE STE 100",
"city": "BLOOMFIELD HILLS",
"state": "MI",
"postal_code": "483025021",
"telephone_number": "248-955-9949",
"fax_number": "248-928-2274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43902 WOODWARD AVE STE 100",
"city": "BLOOMFIELD",
"state": "MI",
"postal_code": "483025021",
"telephone_number": "248-955-9949",
"fax_number": "248-928-2274"
}
],
"practiceLocations": [
{
"address_1": "6255 Inkster Rd Ste 101",
"address_purpose": "LOCATION",
"city": "Garden City",
"state": "MI",
"postal_code": "481352538",
"country_code": "US",
"telephone_number": "248-955-9949",
"fax_number": "248-928-2274",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "INTERNATIONAL MEDICAL CLINIC PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-03-26",
"last_updated": "2024-01-11",
"certification_date": "2024-01-11",
"status": "A",
"authorized_official_last_name": "MADHAVAN",
"authorized_official_first_name": "RAMESH",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "248-955-9949",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Neurology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; 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.