Innovation Medicine, PLLC
Organization Active NPI Internal Medicine Physician · Roseville, MI
NPI 1720511405 · NPPES record last updated Dec 12, 2023
Key facts
- NPI
- 1720511405
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- INNOVATION MEDICINE, PLLC
- Practice address
- 25710 Kelly Rd
Ste 3
Roseville, MI 48066-4959 - Phone
- (586) 772-2600
- NPI assigned
- Apr 10, 2017
- Organization subpart
- No
Authorized official
- Name
- Basem Almasri, M.D.
- Title
- Physician
- Phone
- (586) 772-2600
Practitioners 44
-
Aaron N Achatz, FNP-C
-
Basem Almasri, M.D.
-
Susanne Garay, FNP
-
Osama N Nunu, MD
-
Rudy Jerome Vervaeke, M.D.
-
Sean O'Brien, PA-C
-
Abdulilah Obeid, PA-C
-
Sarah Ventimiglia, PA-C
-
Azza Mohamed Ali, MD
-
Steven D Belen, DO
-
Bethany Jean Brown, R.N., C.N.M.
-
Willie Larry Campbell, LMSW
-
Bayan Chaker, MD
-
Cori Danielle Chase, D.O.
-
Jodie L Gamm, PA
-
Joel J Harris, DO
-
Rolandia Harris, LLMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170501002208 | MI | Part B Supplier - Clinic/Group Practice | 9537446497 |
Receives reassigned benefits from 13 practitioners Practice locations: Detroit, MI; Wyandotte, MI; Warren, MI; Roseville, MI; Mt Clemens, MI |
National Provider Directory
Locations
1040 S Winter St
Adrian, MI 49221
Phone (248) 973-3660
215 North Ave
Ste 220
Mount Clemens, MI 48043
Phone (586) 307-9010
49197 Wixom Tech Dr
Ste B
Wixom, MI 48393
Phone (248) 973-3660
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Addiction Medicine (Internal Medicine) Physician |
207RA0401X |
Addresses
Primary practice location
25710 Kelly Rd
Ste 3
Roseville, MI 48066-4959
Mailing address
25710 Kelly Rd
Ste 3
Roseville, MI 48066-4959
Other providers in Roseville, MI
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- Inner Balance Mental Health LLC
- Innovative Adult Foster Care
- Integrated Health Choices Roseville P.C.
- Integrated Health Choices Roseville PC
- Lenna Ireson
- Wahed Ishaqsei
All providers in Roseville, MI · Internal Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.