Active NPI
Inta J Ertel, MD
- Pediatrics Physician
- Canton, MI
National Provider Identifier
1710901087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4301025548
- Practice address
- 1051 North Canton Center Rd
Canton, MI 48187-5097 - Phone
- (734) 844-5400
- NPI assigned
- Jul 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301025548 | MI | Primary |
| Pediatric Hematology & Oncology Physician | 2080P0207X | 4301025548 | MI |
Addresses
Primary practice location
1051 North Canton Center Rd
Canton, MI 48187-5097
Mailing address
3621 S State St
700 KMS Place Attn Ellen Kayfes
Ann Arbor, MI 48108
Phone (734) 936-2047
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4424521 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301025548 | MI | MD | Pediatric Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330905600000",
"number": "1710901087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 S STATE ST",
"address_2": "700 KMS PLACE ATTN ELLEN KAYFES",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48108",
"telephone_number": "734-936-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1051 NORTH CANTON CENTER RD",
"city": "CANTON",
"state": "MI",
"postal_code": "481875097",
"telephone_number": "734-844-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERTEL",
"first_name": "INTA",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2012-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301025548",
"primary": true
},
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "MI",
"license": "4301025548",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4424521",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.