Active NPI
Maya Soufan, MBBS
- Pediatrics Physician
- Royal Oak, MI
National Provider Identifier
1346979820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4351050036
- Practice address
- 3535 W 13 Mile Rd
Royal Oak, MI 48073 - Phone
- (248) 551-3000
- NPI assigned
- Jun 9, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4351050036 | MI | Primary |
Addresses
Primary practice location
3535 W 13 Mile Rd
Royal Oak, MI 48073
Mailing address
3535 W 13 Mile Rd
Royal Oak, MI 48073
Phone (248) 551-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220613002649 | MI | Order and Referring Only - Pediatric Medicine | 6709265200 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4351050036 | MI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654732800000",
"number": "1346979820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3535 W 13 MILE RD",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "48073",
"telephone_number": "248-551-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 W 13 MILE RD",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "48073",
"telephone_number": "248-551-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUFAN",
"first_name": "MAYA",
"credential": "MBBS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-09",
"last_updated": "2022-06-09",
"certification_date": "2022-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4351050036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.