Provider Demographics
NPI:1942272364
Name:MICHIGAN OPHTHALMOLOGY SPECIALISTS, PLLC
Entity type:Organization
Organization Name:MICHIGAN OPHTHALMOLOGY SPECIALISTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOSSONAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-421-2020
Mailing Address - Street 1:30150 TELEGRAPH RD STE 271
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4521
Mailing Address - Country:US
Mailing Address - Phone:248-395-5175
Mailing Address - Fax:248-395-5170
Practice Address - Street 1:33400 6 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3165
Practice Address - Country:US
Practice Address - Phone:734-421-2020
Practice Address - Fax:734-421-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M94750OtherWPS
MIC30473OtherPALMETTO GBA
MI104983299Medicaid
MI104638662Medicaid
MI104966799Medicaid
MI180H270190OtherBLUE CROSS BLUE SHIELD
MI104485008Medicaid
MI180H270190OtherBLUE CARE NETWORK
MI58117AOtherHEALTH ALLIANCE PLAN OF M
MI=========OtherMI UFCW HEALTH&WELFARE
MIOM94750Medicare ID - Type Unspecified
MI=========OtherAETNA LIFE INSURANCE CO
MI=========OtherAUTOMATED BENEFIT SERVICE
MI=========OtherDMC HEALTH CARE