NPIMap

Individual provider Active NPI

Michael G Edwards, MD

  • Diagnostic Radiology Physician
  • Warren, MI
National Provider Identifier
1750309100
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
049974 Issued in MI
Practice address
11800 E Twelve Mile Road
Warren, MI 48093
Phone
(586) 573-5060
Fax
(586) 573-5197
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 049974 MI Primary

Addresses

Primary practice location

11800 E Twelve Mile Road
Warren, MI 48093

Mailing address

11800 E Twelve Mile Road
Warren, MI 48093
Phone (586) 573-5060

Other identifiers 1

IdentifierTypeStateIssuer
4595091MedicaidMI

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

LicenseStateTypeSpecialty
049974MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Eagle Imaging, LLC Diagnostic Radiology Past Accepting new patients
Wayne Macomb Diagnostic Imaging Center Inc Diagnostic Radiology Past Accepting new patients
Open MRI of Michigan LLC Diagnostic Radiology Past Accepting new patients
Southfield Radiology Associates PLLC Diagnostic Radiology Past Accepting new patients
Michigan Orthopaedic Institute, P.C. PastSince Nov 30, 2015 Accepting new patients
Advanced MRI Imaging, PLLC Diagnostic Radiology PastSince Sep 14, 2008 Accepting new patients
Macomb Magnetic Resonance Imaging Center Inc Diagnostic Radiology Past Accepting new patients
Southfield Radiology Associates, PLLC Diagnostic Radiology Past Accepting new patients
Open MRI of Michigan Past Accepting new patients

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1750309100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 E TWELVE MILE ROAD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48093",
            "telephone_number": "586-573-5060",
            "fax_number": "586-573-5197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 E TWELVE MILE ROAD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48093",
            "telephone_number": "586-573-5060",
            "fax_number": "586-573-5197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "MICHAEL",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "049974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4595091",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.