Michigan Infectious Disease Consultants PC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

MICHIGAN INFECTIOUS DISEASE CONSULTANTS PC

Practice address

44200 Woodward Ave
Suite 101
Pontiac, MI 48341-5046

Phone

(248) 212-0678

Fax

(248) 212-0790

NPI assigned

Jun 5, 2008

Last updated

Sep 26, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shamla A Kalyan, MDNPI 1043237951

Title

Owner

Phone

(248) 212-0678

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 7

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.

• Shamla Kalyan, MD

  • Specialist
  • Pontiac, MI
  • NPI 1043237951

  Infectious Disease

  Medicare reassignment Care Compare group NPD Authorized official
• Suresha Chandani Bandara, M.D.

  • Infectious Disease Physician
  • Bloomfield Hills, MI
  • NPI 1841457454
  Medicare reassignment Care Compare group NPD
• Latha Thiruchelvan Kannan, MD

  • Infectious Disease Physician
  • Southfield, MI
  • NPI 1528015427
  Medicare reassignment Care Compare group NPD
• Amar Krishna

  • Infectious Disease Physician
  • Pontiac, MI
  • NPI 1710234018
  Medicare reassignment Care Compare group NPD
• Lisa May Mercier, MSN, AGAC-BC

  • Acute Care Nurse Practitioner
  • Royal Oak, MI
  • NPI 1699271775
  Medicare reassignment Care Compare group NPD
• Verna Renee Dubord, NP-C

  • Nurse Practitioner
  • Pontiac, MI
  • NPI 1487195566
  Medicare reassignment NPD
• Jerrica Atiyeh, PA-C

  • Medical Physician Assistant
  • Pontiac, MI
  • NPI 1467067975
  Medicare reassignment

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411689600000",
    "number": "1699934554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4920 ADAMS POINTE CT",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480984111",
            "telephone_number": "248-212-0678",
            "fax_number": "248-212-0790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44200 WOODWARD AVE",
            "address_2": "SUITE 101",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415046",
            "telephone_number": "248-212-0678",
            "fax_number": "248-212-0790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN INFECTIOUS DISEASE CONSULTANTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2014-09-26",
        "status": "A",
        "authorized_official_last_name": "KALYAN",
        "authorized_official_first_name": "SHAMLA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-212-0678",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699934554",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "1106366471",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCS",
            "identifier": "440F306450",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1106366471",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4717980",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Infectious Disease Physician in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Infectious Disease Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2014; 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.