Individual provider Active NPI

Teona Maghlakelidze, MD

  • Internal Medicine Physician
  • Midland, MI
National Provider Identifier
1508078023
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301083483 Issued in MI
Practice address
4401 Campus Ridge Dr Ste 1100
Midland, MI 48640-6125
Phone
(989) 837-9200
Fax
(989) 837-9205
NPI assigned
May 4, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301083483 MI Primary

Addresses

Primary practice location

4401 Campus Ridge Dr Ste 1100
Midland, MI 48640-6125

Mailing address

4401 Campus Ridge Dr Ste 1100
Midland, MI 48640-6125
Phone (989) 837-9200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070619000256 MI Practitioner - Internal MedicinePractitioner - Other (Physician) 7214036169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Obesity Medicine and Metabolic Wellness Clinic PLLCGroup PAC ID 6002295722, 6 clinicians

Practice addresses (Care Compare)

2851 N Cedaridge Dr
Midland, MI 48642-8861
Phone (989) 600-1841

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Metabola PLLC CurrentSince May 17, 2022 Accepting new patients
Great Lakes Bay Health Centers Past Accepting new patients
Great Lakes Bay Health Centers Past Accepting new patients

Locations

901 E Indian St
Midland, MI 48640
Phone (989) 832-8803

33 White Tail Creek Rd
Ste 3
Saginaw, MI 48638
Phone (989) 401-5343

565 Progress St
Ste B
West Branch, MI 48661
Phone (989) 345-0748

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1508078023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 CAMPUS RIDGE DR STE 1100",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486406125",
            "telephone_number": "989-837-9200",
            "fax_number": "989-837-9205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 CAMPUS RIDGE DR STE 1100",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486406125",
            "telephone_number": "989-837-9200",
            "fax_number": "989-837-9205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGHLAKELIDZE",
        "first_name": "TEONA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301083483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.