Active NPI
Kathleen Dussan, MD
- Internal Medicine Physician
- Ann Arbor, MI
National Provider Identifier
1952530818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301094150
- Practice address
- 2215 Fuller Rd
Ambulatory Medicine Office
Ann Arbor, MI 48105-2303 - Phone
- (734) 769-7100
- NPI assigned
- Jul 13, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301094150 | MI | Primary |
Addresses
Primary practice location
2215 Fuller Rd
Ambulatory Medicine Office
Ann Arbor, MI 48105-2303
Mailing address
2215 N. Fuller Drive
Ambulatory Medicine Office
Ann Arbor, MI 48105
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140729002332 | WI | Order and Referring Only - Internal Medicine | 5092931949 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301094150 | MI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357776000000",
"number": "1952530818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2215 N. FULLER DRIVE",
"address_2": "AMBULATORY MEDICINE OFFICE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2215 FULLER RD",
"address_2": "AMBULATORY MEDICINE OFFICE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481052303",
"telephone_number": "734-769-7100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUSSAN",
"first_name": "KATHLEEN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-13",
"last_updated": "2013-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301094150",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; 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.