St Mary Mercy Physician Practices | |
36475 5 Mile Rd Livonia MI 48154-1971 | |
(734) 655-4800 | |
(734) 655-2609 |
Full Name | St Mary Mercy Physician Practices |
---|---|
Speciality | Clinic/Center |
Location | 36475 5 Mile Rd, Livonia, Michigan |
Authorized Official Name and Position | David Spivey (PRESIDENT & CEO) |
Authorized Official Contact | 7346551610 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
St Mary Mercy Physician Practices 20555 Victor Pkwy Attn: Se Mi Shared Servicesw3d Chetrinity Health Livonia MI 48152-7031 Ph: (734) 343-0282 | St Mary Mercy Physician Practices 36475 5 Mile Rd Livonia MI 48154-1971 Ph: (734) 655-4800 |
NPI Number | 1568630077 |
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Provider Enumeration Date | 02/19/2008 |
Last Update Date | 11/03/2015 |
Medicare PECOS PAC ID | 4587742804 |
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Medicare Enrollment ID | O20080425000614 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568630077 | NPI | - | NPPES |
010H233560 | Other | MI | BCBS-MI PIN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Randall A Bickle |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1861462830 PECOS PAC ID: 7719974062 Enrollment ID: I20040428001194 |
Provider Name | Anthony Vettraino |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1598811853 PECOS PAC ID: 6901894831 Enrollment ID: I20040430001283 |
Provider Name | Carla Jean Groh |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1821180274 PECOS PAC ID: 3577547769 Enrollment ID: I20040615001515 |
Provider Name | Robert C Brock |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891767695 PECOS PAC ID: 9436190253 Enrollment ID: I20050520000937 |
Provider Name | Tallal M Zeni |
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Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1619995529 PECOS PAC ID: 1254376866 Enrollment ID: I20050623001029 |
Provider Name | Kalappurackal C Joseph |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1922195999 PECOS PAC ID: 5092610725 Enrollment ID: I20051114000595 |
Provider Name | Steven J Karageanes |
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Provider Type | Practitioner - Physical Medicine And Rehabilitation |
Provider Identifiers | NPI Number: 1447293360 PECOS PAC ID: 4385653260 Enrollment ID: I20060420000666 |
Provider Name | Ramneet K Mangat |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1851316657 PECOS PAC ID: 0648274779 Enrollment ID: I20060905000073 |
Provider Name | Ramesh K Mohindra |
---|---|
Provider Type | Practitioner - Hematology/oncology |
Provider Identifiers | NPI Number: 1407827280 PECOS PAC ID: 1456446715 Enrollment ID: I20071001000769 |
Provider Name | Neesha Rochelle Berry |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1134320930 PECOS PAC ID: 1850489105 Enrollment ID: I20071120000291 |
Provider Name | Durga K Yerasuri |
---|---|
Provider Type | Practitioner - Endocrinology |
Provider Identifiers | NPI Number: 1851585582 PECOS PAC ID: 0244320182 Enrollment ID: I20071217000144 |
Provider Name | Richard N Mark |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1649244286 PECOS PAC ID: 1254416019 Enrollment ID: I20080304000852 |
Provider Name | Jowher W Khaleel |
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Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
Provider Identifiers | NPI Number: 1174571947 PECOS PAC ID: 7113096116 Enrollment ID: I20080516000307 |
Provider Name | Michael M Gatt |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1568447050 PECOS PAC ID: 2567531577 Enrollment ID: I20080516000417 |
Provider Name | Srinivasa R Kodali |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1255372058 PECOS PAC ID: 3779653563 Enrollment ID: I20080605000403 |
Provider Name | Tracy A Threat |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1891951711 PECOS PAC ID: 7810057726 Enrollment ID: I20081122000092 |
Provider Name | John J Obrien |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1619088218 PECOS PAC ID: 8022087584 Enrollment ID: I20090521000263 |
Provider Name | Anil K Jain |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1013027309 PECOS PAC ID: 0840341905 Enrollment ID: I20090701000018 |
Provider Name | Jacob Roberts |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1831218817 PECOS PAC ID: 9638225949 Enrollment ID: I20090928000443 |
Provider Name | John Robert Krausman |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1023118312 PECOS PAC ID: 6608914882 Enrollment ID: I20091109000255 |
Provider Name | Ratna Zampani |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1568454254 PECOS PAC ID: 5597865998 Enrollment ID: I20100204000765 |
Provider Name | Prasad L Mikkilineni |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1871585562 PECOS PAC ID: 2961502364 Enrollment ID: I20100204000787 |
Provider Name | Gregory A Monroe |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1598735557 PECOS PAC ID: 6406991389 Enrollment ID: I20100303000405 |
Provider Name | Manzar Y Rajput |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1851358527 PECOS PAC ID: 9335277987 Enrollment ID: I20100503000513 |
Provider Name | Thomas Malcolm Scott |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1467440297 PECOS PAC ID: 5991835746 Enrollment ID: I20100604001083 |
Provider Name | Shyran J Hines-fenderson |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1699933721 PECOS PAC ID: 3274727862 Enrollment ID: I20101027001076 |
Provider Name | Jenny Phu Shih |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457511040 PECOS PAC ID: 9830386887 Enrollment ID: I20101203000272 |
Provider Name | Erin C Walton Doyle |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1427256460 PECOS PAC ID: 1951589902 Enrollment ID: I20110622000649 |
Provider Name | Joan M Moccia |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528365889 PECOS PAC ID: 1254519069 Enrollment ID: I20110627000525 |
Provider Name | Helen M Burns |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1821382979 PECOS PAC ID: 6406020932 Enrollment ID: I20111119000081 |
Provider Name | Bruce M Gimbel |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1669484887 PECOS PAC ID: 0345403358 Enrollment ID: I20120531000050 |
Provider Name | William S Cardasis |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1326198276 PECOS PAC ID: 0941464549 Enrollment ID: I20120612000072 |
Provider Name | Terri L Mack |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1851410617 PECOS PAC ID: 8729242870 Enrollment ID: I20120621000177 |
Provider Name | Barbra R Alvir |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1376664813 PECOS PAC ID: 8921230111 Enrollment ID: I20140423000739 |
Provider Name | Samuel H Wedes |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1194031062 PECOS PAC ID: 8527286764 Enrollment ID: I20140829000142 |
Provider Name | Shahbaz Shahid Nisar |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1659647717 PECOS PAC ID: 6103137492 Enrollment ID: I20150612000163 |
Provider Name | Salim A Hamadeh |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1194024364 PECOS PAC ID: 7113230475 Enrollment ID: I20150716001146 |
Provider Name | Mark A Jonker |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1780620039 PECOS PAC ID: 1355587080 Enrollment ID: I20151008000568 |
Provider Name | James C Segerson |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1467480186 PECOS PAC ID: 4688979719 Enrollment ID: I20160226000945 |
Provider Name | Natalie L Crook |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477929255 PECOS PAC ID: 8123326907 Enrollment ID: I20160412000084 |
Provider Name | Brandon G Moore |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1083902977 PECOS PAC ID: 7517197692 Enrollment ID: I20160721002552 |
Provider Name | Eric Davies |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1427374917 PECOS PAC ID: 3870738263 Enrollment ID: I20160810001973 |
Provider Name | Meredith Chapel |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1093267353 PECOS PAC ID: 2163701558 Enrollment ID: I20161107001596 |
Provider Name | Margaret Wells |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1265552004 PECOS PAC ID: 0840519633 Enrollment ID: I20170404000458 |
Provider Name | Margaret Ann Meyers |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609884626 PECOS PAC ID: 1658698733 Enrollment ID: I20170404000787 |
Provider Name | Pamela B Williams |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1821191180 PECOS PAC ID: 7911224894 Enrollment ID: I20170404000948 |
Provider Name | Cheryl Ann Cascio |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1093248916 PECOS PAC ID: 5799054078 Enrollment ID: I20170629001080 |
Provider Name | Rachel B Marcucci |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1902167737 PECOS PAC ID: 7416251244 Enrollment ID: I20170831001671 |
Provider Name | Jessica M O'mara |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1457766917 PECOS PAC ID: 5890090914 Enrollment ID: I20170914000352 |
Provider Name | Alan Sabah Putrus |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1366784001 PECOS PAC ID: 3274844329 Enrollment ID: I20170922002819 |
Provider Name | Louis C Cavadini |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1023422128 PECOS PAC ID: 1153546486 Enrollment ID: I20171012001531 |
Provider Name | Chelsey Christen Forry |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1396182648 PECOS PAC ID: 4789968694 Enrollment ID: I20180504000269 |
Provider Name | Biju Poulose |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1760876601 PECOS PAC ID: 1557663259 Enrollment ID: I20180613002022 |
Provider Name | Aimee H Dereczyk |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1972921757 PECOS PAC ID: 8921304189 Enrollment ID: I20180621000287 |
Provider Name | Ronald M Liebman |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1649698135 PECOS PAC ID: 7012210495 Enrollment ID: I20180820001963 |
Provider Name | Kayla S Garrett |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447754627 PECOS PAC ID: 2769727858 Enrollment ID: I20181218001866 |
Provider Name | Kimberly Pike-moesta |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1700358975 PECOS PAC ID: 5890032718 Enrollment ID: I20190130000424 |
Provider Name | Kevin Sethi |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1922480680 PECOS PAC ID: 8921318346 Enrollment ID: I20190208002500 |
Provider Name | Amanda J. Warren |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1205229036 PECOS PAC ID: 2466795315 Enrollment ID: I20190517000221 |
Provider Name | Renee L Bayer |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1114312634 PECOS PAC ID: 5294044020 Enrollment ID: I20190624003316 |
Provider Name | Courtney Paladino |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1023453453 PECOS PAC ID: 7618207895 Enrollment ID: I20191002000121 |
Provider Name | Karamjeet K Sandhu |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164811204 PECOS PAC ID: 4385076389 Enrollment ID: I20191113000642 |
Provider Name | Cayla Marie Yuhn |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1194283200 PECOS PAC ID: 8022430172 Enrollment ID: I20200619000228 |
Provider Name | Danielle P Zazaian |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1902336100 PECOS PAC ID: 5698045144 Enrollment ID: I20210520000757 |
Provider Name | Lorna Blakian Burns |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1801465034 PECOS PAC ID: 1153724299 Enrollment ID: I20210727000972 |
Provider Name | Mohammad T Rauf |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1134582737 PECOS PAC ID: 1759671415 Enrollment ID: I20220111000440 |
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