Individual provider Active NPI

Ketan Tolia, MD

  • Internal Medicine Physician
  • Southfield, MI
National Provider Identifier
1710988688
Registry record updated Aug 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301054022 Issued in MI
Practice address
22255 Greenfield
400
Southfield, MI 48075
Phone
(248) 465-4010
Fax
(248) 465-4011
NPI assigned
Aug 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301054022 MI Primary

Addresses

Primary practice location

22255 Greenfield
400
Southfield, MI 48075

Mailing address

26850 Providence Pkwy
Pmob#200
Novi, MI 48374-1213
Phone (248) 465-3144

Other identifiers 1

IdentifierTypeStateIssuer
447791910MedicaidMI

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071115000196 MI Practitioner - Internal Medicine 6608964291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

22255 Greenfield Rd
Suite 400
Southfield, MI 48075-3734
Phone (248) 849-4880

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Providence Hospital Current Accepting new patients
Henry Ford Health Providence Hospital Past Accepting new patients

Locations

26850 Providence Pkwy
Ste 200
Novi, MI 48374

47601 Grand River Ave
Ste B136
Novi, MI 48374
Phone (248) 465-3940

16001 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 424-3000

16001 W 9 Mile Rd
Fl 5
Southfield, MI 48075
Phone (248) 380-4335

Interoperability endpoints

  • Direct secure messaging: ktolia1155785@direct.hfhs.org

Organizations & group practices 2

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 4

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": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376352000000",
    "number": "1710988688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26850 PROVIDENCE PKWY",
            "address_2": "PMOB#200",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483741213",
            "telephone_number": "248-465-3144",
            "fax_number": "248-465-3146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22255 GREENFIELD",
            "address_2": "400",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "248-465-4010",
            "fax_number": "248-465-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLIA",
        "first_name": "KETAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2013-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301054022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "447791910",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.