Bobbi Edwards MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

BE063204 Issued in MI

Legal business name

BOBBI EDWARDS MD PC

Practice address

24901 Northwestern Hwy
Suite 214
Southfield, MI 48075

Phone

(248) 483-8488

Fax

(248) 483-8489

NPI assigned

Sep 6, 2007

Last updated

Sep 6, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bobbi Edwards, MDNPI 1376556712

Title

President

Phone

(248) 483-8486

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bobbi Edwards, MD

  • Dermatology Physician
  • Southfield, MI
  • NPI 1376556712
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536192000000",
    "number": "1477748184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19315 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480756596",
            "telephone_number": "248-483-8488",
            "fax_number": "248-325-8967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24901 NORTHWESTERN HWY",
            "address_2": "SUITE 214",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "248-483-8488",
            "fax_number": "248-483-8489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24901 Northwestern Hwy",
            "address_2": "Suite 214",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480752203",
            "country_code": "US",
            "telephone_number": "248-483-8488",
            "fax_number": "248-483-8489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BOBBI EDWARDS MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2018-09-06",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "BOBBI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-483-8486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "BE063204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MI",
            "identifier": "0706339290",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND  DC MEDICARE PIN NUMBER",
            "identifier": "264628YMPJ",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Southfield, MI
• Providers in Southfield, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.