NPIMap

Organization Active NPI

Kidney Care Specialists of Michigan PC

  • Nephrology Physician
  • Saint Clair Shores, MI
National Provider Identifier
1588960298
Registry record updated Jun 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
KIDNEY CARE SPECIALISTS OF MICHIGAN PC
Practice address
29001 Harper Ave
Saint Clair Shores, MI 48081-2711
Phone
(586) 778-0664
Fax
(586) 778-0396
NPI assigned
Jan 28, 2011
Last updated
Jun 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2015

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

Authorized official

Name
Dr. Faten Suleiman Ayyoub, M.D.NPI 1881650760
Title
President
Phone
(586) 778-0664

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

29001 Harper Ave
Saint Clair Shores, MI 48081-2711

Mailing address

2250 Hawthorne Dr S
Shelby TWP, MI 48316-5536
Phone (586) 778-0664

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110427000316 MI Part B Supplier - Clinic/Group Practice 5597940080 Receives reassigned benefits from 8 practitioners
Practice locations: Warren, MI; Troy, MI; Sterling Heights, MI; Saint Clair Shores, MI; Pontiac, MI; Grosse Pointe, MI; Detroit, MI; Clinton Township, MI

National Provider Directory

National Provider Directory
Tax ID family
Kidney Care Specialists of Mi2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

29001 Harper Ave
St Clr Shores, MI 48081
Phone (586) 778-0664

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1296172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1588960298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 HAWTHORNE DR S",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483165536",
            "telephone_number": "586-778-0664",
            "fax_number": "586-778-0396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29001 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812711",
            "telephone_number": "586-778-0664",
            "fax_number": "586-778-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CARE SPECIALISTS OF MICHIGAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-28",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "AYYOUB",
        "authorized_official_first_name": "FATEN",
        "authorized_official_middle_name": "SULEIMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-778-0664",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; 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.