Active NPI
Michael Park, M.D.
- Allergy & Immunology Physician
- Portage, MI
National Provider Identifier
1942204680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- 4301063179
- Practice address
- 430 W Centre Ave
Portage, MI 49024-5304 - Phone
- (269) 321-6673
- Fax
- (269) 324-5594
- NPI assigned
- Jun 10, 2005
- Last updated
- Apr 22, 2026
- 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 |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | 4301063179 | MI | Primary |
Addresses
Primary practice location
430 W Centre Ave
Portage, MI 49024-5304
Mailing address
430 W Centre Ave
Portage, MI 49024-5304
Phone (269) 321-6673
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4111376 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2010 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Allergy Center PC | Allergy & Immunology | Current | Accepting new patients |
| Paragon Health PC | Past | Accepting new patients |
Locations
430 W Centre Ave
Portage, MI 49024
Phone (269) 321-6673
Organizations & group practices 2
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.
-
- Allergy & Immunology Physician
- Portage, MI
- NPI 1487100350
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776816000000",
"number": "1942204680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 W CENTRE AVE",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490245304",
"telephone_number": "269-321-6673",
"fax_number": "269-324-5594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 W CENTRE AVE",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490245304",
"telephone_number": "269-321-6673",
"fax_number": "269-324-5594"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-10",
"last_updated": "2026-04-22",
"certification_date": "2026-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "MI",
"license": "4301063179",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4111376",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.