Active NPI
Ted Podeszwa, DO
- Internal Medicine Physician
- Livonia, MI
National Provider Identifier
1356387708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 5101005210
- Practice address
- 28711 8 Mile Rd
Suite D
Livonia, MI 48152-2040 - Phone
- (248) 474-2220
- Fax
- (248) 474-5273
- NPI assigned
- Jun 22, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 5101005210 | MI | Primary |
Addresses
Primary practice location
28711 8 Mile Rd
Suite D
Livonia, MI 48152-2040
Mailing address
28711 8 Mile Rd
Suite D
Livonia, MI 48152-2040
Phone (248) 474-2220
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4102835 | Other | MI | AETNA |
| P46981 | Other | MI | BLUE CROSS |
| 2875701 | Medicaid | MI | |
| B4340 | Other | MI | MCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101005210 | MI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Millennium Medical Group West PC | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Westland, MI
- NPI 1447352075
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356387708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28711 8 MILE RD",
"address_2": "SUITE D",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481522040",
"telephone_number": "248-474-2220",
"fax_number": "248-474-5273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28711 8 MILE RD",
"address_2": "SUITE D",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481522040",
"telephone_number": "248-474-2220",
"fax_number": "248-474-5273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PODESZWA",
"first_name": "TED",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "5101005210",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4102835",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "P46981",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2875701",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCARE",
"identifier": "B4340",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
- Alexandra Rosalyn Pletzke
- Plymouth Physical Therapy Specialists Limited Partnership
- Plymouth Physical Therapy Specialists Limited Partnership
- Plymouth Physical Therapy Specialists LP
- Plymouth RX LLC
- Kate Ildiko Pogany, LMSW
- Cameron Pogorel, DPT
- Joely Annette Pointer
- Ashley Elizabeth Poirier, FNP
- Thomas E Pokora, CCP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.