John P. Ilitch, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

14256 Issued in MI

Practice address

15311 W McNichols Rd
Detroit, MI 48235-3723

Phone

(313) 838-0490

Fax

(248) 539-3347

NPI assigned

Feb 6, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dental Care Management, Inc.

  • Dental Clinic/Center
  • Detroit, MI
  • NPI 1528139540
  NPD (past) Authorized official

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720127384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17770 STONEBROOK DR",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481684329",
            "telephone_number": "313-838-0490",
            "fax_number": "248-539-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15311 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353723",
            "telephone_number": "313-838-0490",
            "fax_number": "248-539-3347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILITCH",
        "first_name": "JOHN",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "14256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "14256",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunday T C Ilechukwu, MD
• Marvina Darlene Iler
• Karl Joseph Ilg, MD
• Handenur Ilgun, MD
• MD Ilias, MD
• Janis Illson, CRNA
• Omar Ilyas, MD
• Viktor Ilyasov, DO
• Im Consultant
• Jacob Junhyuk Im, MD

• Dentist in Detroit, MI
• Providers in Detroit, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.