Individual provider Active NPI

Michelle Miran Kim, M.D.

  • Radiation Oncology Physician
  • Ann Arbor, MI
National Provider Identifier
1972777175
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
4301104181 Issued in MI
Practice address
1500 E Medical Center Drive
B2 Floor University Hospital RM C490
Ann Arbor, MI 48109-5010
Phone
(734) 936-4300
NPI assigned
Apr 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 4301104181 MI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1500 E Medical Center Drive
B2 Floor University Hospital RM C490
Ann Arbor, MI 48109-5010

Mailing address

3621 South State Street
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140210000069 MI Practitioner - Radiation Oncology 3072742303 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of MichiganGroup PAC ID 3779496856, 3,344 clinicians

Practice addresses (Care Compare)

1500 E Medical Ctr Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4300

Hospital & facility affiliations

  • University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301104181MIMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Michigan Cancer Center Radiation Oncology CurrentSince Oct 22, 2013 Accepting new patients
Northeastern Michigan Cancer Center Radiation Oncology CurrentSince Oct 22, 2013 Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1501 W Chisholm St
Alpena, MI 49707
Phone (989) 356-7000

1500 E Medical Center Dr
Rm C490
Ann Arbor, MI 48109
Phone (734) 936-4300

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

47601 Grand River Ave
Novi, MI 48374
Phone (248) 465-4100

5950 Metro Way SW
Wyoming, MI 49519
Phone (616) 252-8100

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468454400000",
    "number": "1972777175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 SOUTH STATE STREET",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DRIVE",
            "address_2": "B2 FLOOR UNIVERSITY HOSPITAL RM C490",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095010",
            "telephone_number": "734-936-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MICHELLE",
        "middle_name": "MIRAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-17",
        "last_updated": "2016-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MI",
            "license": "4301104181",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.