NPIMap

Organization Active NPI

Reza Kahnamouei MD PLLC

  • Adult Medicine Physician
  • Clinton TWP, MI
National Provider Identifier
1861753725
Registry record updated Feb 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
4301090040 Issued in MI
Legal business name
REZA KAHNAMOUEI MD PLLC
Practice address
43301 Commons Dr
Clinton TWP, MI 48038-1109
Phone
(586) 745-3006
Fax
(586) 935-3762
NPI assigned
Jun 6, 2012
Last updated
Feb 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2014

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

Authorized official

Name
Dr. Mohammadreza Kahnamouei, M.D.NPI 1467651026
Title
Sole Member
Phone
(313) 622-0582

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X 4301090040 MI Primary

Addresses

Primary practice location

43301 Commons Dr
Clinton TWP, MI 48038-1109

Mailing address

1401 Kirkway Rd
Bloomfield Hills, MI 48302-1318
Phone (313) 622-0582

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121018000309 MI Part B Supplier - Clinic/Group Practice 7911157425 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Clinton TWP, MI; Imlay City, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Reza Kahnamouei MD PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

43361 Commons Dr
Clinton Twp, MI 48038
Phone (586) 286-2620

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392508800000",
    "number": "1861753725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 KIRKWAY RD",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483021318",
            "telephone_number": "313-622-0582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43301 COMMONS DR",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381109",
            "telephone_number": "586-745-3006",
            "fax_number": "586-935-3762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REZA KAHNAMOUEI MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2014-02-16",
        "status": "A",
        "authorized_official_last_name": "KAHNAMOUEI",
        "authorized_official_first_name": "MOHAMMADREZA",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "313-622-0582",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MI",
            "license": "4301090040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton TWP, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.