Imhotep Medical Services, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M4301056553 Issued in MI

Legal business name

IMHOTEP MEDICAL SERVICES, INC.

Practice address

5525 Greenway St
Detroit, MI 48204-2112

Phone

(313) 935-0399

Fax

(313) 931-9113

NPI assigned

Apr 6, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Connie L Mitchell, M.D.

Title

Owner, Physician

Phone

(313) 701-1187

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412553600000",
    "number": "1386767473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5525 GREENWAY ST",
            "address_2": "SUITE B - 2",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482042112",
            "telephone_number": "313-701-1187",
            "fax_number": "313-931-9113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5525 GREENWAY ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482042112",
            "telephone_number": "313-935-0399",
            "fax_number": "313-931-9113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMHOTEP MEDICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2014-10-06",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER, PHYSICIAN",
        "authorized_official_telephone_number": "313-701-1187",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "M4301056553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4706980",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Detroit, MI
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• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2014; 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.