Individual provider Active NPI

Gretchen Marie Jakubiak, NP

  • Nurse Practitioner
  • Northville, MI
National Provider Identifier
1609169184
Registry record updated Nov 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704215872 Issued in MI
Practice address
15474 Haggerty Rd
Northville, MI 48170-4890
Phone
(734) 335-6103
Fax
(734) 404-5317
NPI assigned
May 17, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704215872 MI Primary

Addresses

Primary practice location

15474 Haggerty Rd
Northville, MI 48170-4890

Mailing address

901 McClintock Dr
Suite 202
Burr Ridge, IL 60527-0871
Phone (888) 220-6432

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120113000603 MI Practitioner - Nurse Practitioner 1850568841 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

15474 N Haggerty Rd
Plymouth, MI 48170-4893
Phone (734) 335-6103

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704215872MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Infectious Disease Consultants LLC CurrentSince Feb 27, 2012 Accepting new patients
Metro Infectious Disease Consultants, LLC Nurse Practitioner CurrentSince Feb 27, 2012 Accepting new patients
Metro Infectious Disease Consultants, LLC Past Accepting new patients

Locations

901 McClintock Dr
Ste 202
Burr Ridge, IL 60527
Phone (630) 654-4201

6245 Inkster Rd
Garden City, MI 48135
Phone (734) 421-3300

15474 N Haggerty Rd
Plymouth, MI 48170
Phone (734) 335-6103

27209 Lahser Rd
Ste 120
Southfield, MI 48034
Phone (248) 358-4892

14510 Northline Rd
Southgate, MI 48195
Phone (734) 282-2800

5280 Metropolitan Pkwy
Sterling Heights, MI 48310
Phone (586) 446-8688

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479859200000",
    "number": "1609169184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MCCLINTOCK DR",
            "address_2": "SUITE 202",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605270871",
            "telephone_number": "888-220-6432",
            "fax_number": "630-654-4253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15474 HAGGERTY RD",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481704890",
            "telephone_number": "734-335-6103",
            "fax_number": "734-404-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAKUBIAK",
        "first_name": "GRETCHEN",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-17",
        "last_updated": "2016-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704215872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northville, MI

Sources for this page

Verify at the official NPI Registry.