Ian John Detroyer, MD
Individual provider Active NPI Surgery Physician · Detroit, MI
NPI 1356101679 · NPPES record last updated Jun 29, 2024
Key facts
- NPI
- 1356101679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 4351052334 (MI)
- Practice address
- 22151 Moross Rd Ste 214
Detroit, MI 48236-2151 - Phone
- (313) 343-4867
- Fax
- (313) 343-3280
- NPI assigned
- Mar 21, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240803000391 | MI | Order and Referring Only - General Surgery |
8426595760 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4351052334 | MI | Yes |
Addresses
Primary practice location
22151 Moross Rd Ste 214
Detroit, MI 48236-2151
Mailing address
22151 Moross Rd Ste 214
Detroit, MI 48236-2151
Phone (313) 343-4867
Other providers in Detroit, MI
- Detroit Wayne Integrated Health Network
- Detroit Wayne Mental Health Authority
- Detroit Wayne Mental Health Authority
- Detroit Wayne Mental Health Authority
- Detroit-Macomb Hospital Corporation
- Diane Deutsch-Keahey
- Sarayu Devabhaktuni
- Anupama Devara
- Development Centers
- Development Centers, Inc.
All providers in Detroit, MI · Surgery Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.