Active NPI
Keinnan Hares
- Student in an Organized Health Care Education/Training Program
- Detroit, MI
National Provider Identifier
1528853900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 3990 John R St Ste 615
Detroit, MI 48201-2018 - Phone
- (313) 745-4195
- Fax
- (313) 993-8669
- NPI assigned
- Apr 14, 2025
- Last updated
- Apr 14, 2025
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | Primary |
Addresses
Primary practice location
3990 John R St Ste 615
Detroit, MI 48201-2018
Mailing address
7015 Balmoral Dr
West Bloomfield, MI 48322-2775
Phone (248) 318-6799
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250707002065 | MI | Order and Referring Only - General Surgery | 5597279257 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1744588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744588800000",
"number": "1528853900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7015 BALMORAL DR",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483222775",
"telephone_number": "248-318-6799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3990 JOHN R ST STE 615",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012018",
"telephone_number": "313-745-4195",
"fax_number": "313-993-8669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARES",
"first_name": "KEINNAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-04-14",
"last_updated": "2025-04-14",
"certification_date": "2025-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.