NPIMap

Organization Active NPI

Wyandotte Physician Practices

Doing business as Downriver Internist PC

  • Internal Medicine Physician
  • Southgate, MI
National Provider Identifier
1316203102
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301048664 Issued in MI
Legal business name
WYANDOTTE PHYSICIAN PRACTICES
Doing business as
Downriver Internist PC
Practice address
15450 Northline Rd Ste 101
Southgate, MI 48195-2490
Phone
(734) 224-3679
Fax
(734) 287-9926
NPI assigned
Apr 5, 2012
Last updated
Jun 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Jacob Budd
Title
Director Physician Practices
Phone
(734) 391-3057

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301048664 MI Primary

Addresses

Primary practice location

15450 Northline Rd Ste 101
Southgate, MI 48195-2490

Mailing address

1640 Fort Street
Suite D Attn Denise
Trenton, MI 48183
Phone (734) 391-3057

Other names 1

  • Downriver Internist PC Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

23050 West Rd
Ste 240
Brownstown Twp, MI 48183
Phone (734) 281-4197

21969 Huron River Dr
Rockwood, MI 48173
Phone (734) 379-1906

1848 Biddle Ave
Wyandotte, MI 48192
Phone (313) 386-3200

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1316203102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 FORT STREET",
            "address_2": "SUITE D ATTN DENISE",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "48183",
            "telephone_number": "734-391-3057",
            "fax_number": "734-391-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15450 NORTHLINE RD STE 101",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952490",
            "telephone_number": "734-224-3679",
            "fax_number": "734-287-9926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYANDOTTE PHYSICIAN PRACTICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-05",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "BUDD",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "DIRECTOR PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "734-391-3057"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301048664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Downriver Internist PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southgate, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.