NPIMap

Individual provider Active NPI

Maciej R Uzieblo, MD

  • Vascular Surgery Physician
  • Troy, MI
National Provider Identifier
1508840315
Registry record updated Apr 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
4301065654 Issued in MI
Practice address
525 East Big Beaver Rd
Suite 125
Troy, MI 48083
Phone
(248) 688-9860
Fax
(248) 688-9861
NPI assigned
Dec 5, 2005
Last updated
Apr 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 4301065654 MI Primary

Addresses

Primary practice location

525 East Big Beaver Rd
Suite 125
Troy, MI 48083

Mailing address

525 East Big Beaver Rd
Suite 125
Troy, MI 48083
Phone (248) 688-9860

Other identifiers 1

IdentifierTypeStateIssuer
104647142MedicaidMI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address muzieblo9085@direct.beaumont.edu
Direct Messaging Address muzieblo9085@direct.beaumont.edu

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040313000708 MI Practitioner - Vascular Surgery 8224927595 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Wayne State University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vascular and Endovascular Associates PLCGroup PAC ID 2961479522, 6 clinicians

Practice addresses (Care Compare)

28100 Grand River Ave
Farmington Hills, MI 48336-5970

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

3601 W 13 Mile Rd Ec
Beaumont Emergency Services Ro
Royal Oak, MI 48073-6712
Phone (248) 898-5058

4949 Coolidge Hwy
Royal Oak, MI 48073-1026
Phone (248) 655-3220

525 E Big Beaver Rd
Suite 125
Troy, MI 48083-1367
Phone 24868898606

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion26
Varicose vein removal1-10
Leg revascularization (restoring blood flow)30
Removal of tissue18

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
VHS Physicians of Michigan CurrentSince Jul 28, 2021 Accepting new patients
Vascular & Endovascular Associates PLC Vascular Surgery CurrentSince Oct 1, 2004 Accepting new patients
Beaumont Medical Group- Specialty Services CurrentSince Mar 24, 2018 Accepting new patients
St Clair Specialty Physicians PC Vascular Surgery Past Accepting new patients
University Physician Group Past Accepting new patients
William Beaumont Hospital Past Accepting new patients
Premier Surgical Specialists, PC Past Accepting new patients

Locations

28905 Woodward Ave
Berkley, MI 48072
Phone (248) 544-2293

311 Mack Ave
Ste 63100
Detroit, MI 48201
Phone (313) 536-1525

311 Mack Ave
Ste 64100
Detroit, MI 48201
Phone (313) 832-0303

3901 Beaubien St
Detroit, MI 48201
Phone (313) 745-5227

3990 John R St
Detroit, MI 48201
Phone (313) 745-6211

3990 John R St
Ofc
Detroit, MI 48201

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

4160 John R St
Ste 615
Detroit, MI 48201
Phone (313) 745-5111

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

3601 W 13 Mile Rd
Royal Oak, MI 48073

4949 Coolidge Hwy
Royal Oak, MI 48073
Phone (248) 655-5660

29201 Telegraph Rd
Ste 200
Southfield, MI 48034
Phone (248) 357-5000

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

525 E Big Beaver Rd
Ste 125
Troy, MI 48083
Phone (248) 688-9860

Interoperability endpoints

  • Direct secure messaging: maciej.uzieblo.1@9704.direct.athenahealth.com
  • Direct secure messaging: muzieblo812174@direct.hfhs.org

Organizations & group practices 7

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1508840315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 EAST BIG BEAVER RD",
            "address_2": "SUITE 125",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48083",
            "telephone_number": "248-688-9860",
            "fax_number": "248-688-9861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 EAST BIG BEAVER RD",
            "address_2": "SUITE 125",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48083",
            "telephone_number": "248-688-9860",
            "fax_number": "248-688-9861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UZIEBLO",
        "first_name": "MACIEJ",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301065654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104647142",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "muzieblo9085@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "525 East Big Beaver Rd",
            "address_2": "Suite 125",
            "city": "Troy",
            "state": "MI",
            "country_code": "US",
            "postal_code": "48083",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "muzieblo9085@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "525 East Big Beaver Rd",
            "address_2": "Suite 125",
            "city": "Troy",
            "state": "MI",
            "country_code": "US",
            "postal_code": "48083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.