Active NPI
Aleksander A Domiczek, MD
- Family Medicine Physician
- Mount Clemens, MI
National Provider Identifier
1427049683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301048524
- Practice address
- 18 Market St
Mount Clemens, MI 48043 - Phone
- (586) 783-2222
- Fax
- (586) 783-6280
- NPI assigned
- Nov 4, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301048524 | MI | Primary |
Addresses
Primary practice location
18 Market St
Mount Clemens, MI 48043
Mailing address
6800 E 10 Mile Rd
Center Line, MI 48015-1167
Phone (586) 619-9986
Other identifiers 18
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0804400591 | Other | MI | BLUE CROSS INDIVIDUAL |
| 080D410020 | Other | MA | COMMUNITY BLUE |
| 253226 | Other | MI | MCLAREN HEALTH PLAN |
| B43001 | Other | MI | HEALTH NET FEDERAL |
| 080D410020 | Other | MI | BLUE CROSS BLUE SHIELD |
| 92588990011 | Other | MI | CIGNA |
| 080162065 | Other | MI | METRAHEALTH |
| 080D410020 | Other | MI | BLUE CROSS POS |
| 4105744 | Other | MI | AETNA |
| 0805026931 | Other | MI | BCN IND |
| 080D410020 | Other | MI | BLUE CARE NETWORK |
| 253226 | Other | MI | HEALTH ADVANTAGE NETWORK |
| 4244111 | Medicaid | MI | |
| 0805026931 | Other | MI | BCBS IND |
| 0988917 | Other | MI | HEALTH PLUS |
| B43001 | Other | MI | HEALTH ALLIANCE PLAN |
| C7390 | Other | MI | MCARE |
| 1427049683 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301048524 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531872000000",
"number": "1427049683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6800 E 10 MILE RD",
"city": "CENTER LINE",
"state": "MI",
"postal_code": "480151167",
"telephone_number": "586-619-9986",
"fax_number": "586-806-5085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 MARKET ST",
"city": "MOUNT CLEMENS",
"state": "MI",
"postal_code": "48043",
"telephone_number": "586-783-2222",
"fax_number": "586-783-6280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMICZEK",
"first_name": "ALEKSANDER",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-04",
"last_updated": "2018-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301048524",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS INDIVIDUAL",
"identifier": "0804400591",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMUNITY BLUE",
"identifier": "080D410020",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN",
"identifier": "253226",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET FEDERAL",
"identifier": "B43001",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "080D410020",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "92588990011",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "METRAHEALTH",
"identifier": "080162065",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS POS",
"identifier": "080D410020",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4105744",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCN IND",
"identifier": "0805026931",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "080D410020",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ADVANTAGE NETWORK",
"identifier": "253226",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4244111",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS IND",
"identifier": "0805026931",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLUS",
"identifier": "0988917",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE PLAN",
"identifier": "B43001",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCARE",
"identifier": "C7390",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1427049683",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Clemens, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.