Active NPI
Andrew Atisha, DMD
- Dentist
- Detroit, MI
National Provider Identifier
1932581998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5315071893
- Practice address
- 2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576 - Phone
- (313) 494-6700
- NPI assigned
- Jun 25, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5315071893 | MI | Primary |
Addresses
Primary practice location
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Mailing address
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Phone (313) 494-6700
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160525000058 | MI | Order and Referring Only - Dentist | 7911296330 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5315071893 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461628800000",
"number": "1932581998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 MARTIN LUTHER KING JR BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482082576",
"telephone_number": "313-494-6700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 MARTIN LUTHER KING JR BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482082576",
"telephone_number": "313-494-6700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ATISHA",
"first_name": "ANDREW",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-25",
"last_updated": "2016-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "5315071893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2016; 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.