NPI Number: 1003155607

Clasification: Internal Medicine (207R00000X)

26677 W 12 MILE RD
ZIP 48034

Phone Number: (248) 358-6995

Detailed Information

MAECENAS HEALTH SYSTEMS PC is an internist in Southfield, MI. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. The assigned NPI number for this provider is 1003155607 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

26677 W 12 MILE RD
ZIP 48034-514
Phone: (248) 358-6995

The provider's authorized official is Solomon Chukwuemeka Awusah .
The authorized official title is President and has the following contact phone number (248) 790-5808.

The enumeration date for this NPI number is 2/4/2013 and was last updated on 2/15/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207R00000X Internal Medicine 4301093171 MI Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1003155607 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name MAECENAS HEALTH SYSTEMS PC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 26677 W 12 MILE RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name SOUTHFIELD The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name MI The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 480341514 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 2483586995 The telephone number associated with the location address of the provider being identified.
11 Provider Enumeration Date 2/4/2013 The date the provider was assigned a unique identifier (assigned an NPI).
12 Last Update Date 2/15/2013 The date that a record was last updated or changed.
13 Authorized Official Last Name AWUSAH The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
14 Authorized Official First Name SOLOMON The first name of the authorized official.
15 Authorized Official Middle Name CHUKWUEMEKA The middle name of the authorized official.
16 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
17 Authorized Official Telephone Number 2487905808 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 207R00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 4301093171 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 1 MI The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text DR.
24 Authorized Official Credential Text MD
25 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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