NPIMap

Individual provider Active NPI

Mazin Putrus Yonan, MD

  • Internal Medicine Physician
  • Troy, MI
National Provider Identifier
1801888904
Registry record updated Oct 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MY075033 Issued in MI
Practice address
2221 Livernois Rd
100
Troy, MI 48083-1603
Phone
(248) 250-9474
Fax
(248) 250-9483
NPI assigned
Aug 16, 2005
Last updated
Oct 27, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2011

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 MY075033 MI Primary

Addresses

Primary practice location

2221 Livernois Rd
100
Troy, MI 48083-1603

Mailing address

2221 Livernois Rd
100
Troy, MI 48083-1603
Phone (248) 250-9474

Other identifiers 1

IdentifierTypeStateIssuer
409819410MedicaidMI

Other names 1

  • Mazin Putrus Audish Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040921000149 MI Practitioner - Internal Medicine 5799753463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2221 Livernois Rd
Suite 100
Troy, MI 48083-1603
Phone (248) 250-9474

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MY075033MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mathews Medical Center PLLC Internal Medicine CurrentSince Dec 1, 2004 Accepting new patients
Hope Medical Center of Michigan PC Internal Medicine Past Accepting new patients
Agy Medical Group PC Internal Medicine Past Accepting new patients
William Beaumont Hospital Past Accepting new patients

Locations

3601 W 13 Mile Rd
Royal Oak, MI 48073

2221 Livernois Rd
Ste 100
Troy, MI 48083
Phone (248) 250-8233

Organizations & group practices 4

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319673600000",
    "number": "1801888904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 LIVERNOIS RD",
            "address_2": "100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831603",
            "telephone_number": "248-250-9474",
            "fax_number": "248-250-9483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 LIVERNOIS RD",
            "address_2": "100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831603",
            "telephone_number": "248-250-9474",
            "fax_number": "248-250-9483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YONAN",
        "first_name": "MAZIN",
        "middle_name": "PUTRUS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2011-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "MY075033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409819410",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAZIN",
            "last_name": "AUDISH",
            "middle_name": "PUTRUS",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.