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WAYNE STATE UNIVERSITY PHYSICIAN GROUP
NPI 1063452233
Optometrist in Detroit, MI

Active since June 07, 2006CLIA Certified · 2 labs
4717 SAINT ANTOINE ST, DETROIT, MI 48201(313) 577-8900(313) 577-0700 Get Directions Write a Review

NPPES record last updated: October 26, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 26, 2016, May 18, 2016, Feb 16, 2016 (3 updates tracked since 2016).

About Wayne State University Physician Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WAYNE STATE UNIVERSITY PHYSICIAN GROUP (NPI 1063452233) is a healthcare organization registered as an optometrist in Detroit, Michigan and active in the NPI registry since June 2006. The organization holds 2 active CLIA laboratory certificates and lists Jeffery P Kohlitz, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1063452233
Entity TypeOrganization
Primary Taxonomy152W00000X
Legal Business NameUNIVERSITY PHYSICIAN GROUP
Location Address4717 SAINT ANTOINE STDetroit, MI 48201-1423
Mailing Address1560 E. Maple Rd., Suite 400-credentialing Dept.Troy, MI 48083-1138 · (248) 581-5973 · Fax (248) 581-5640
Phone(313) 577-8900
Fax(313) 577-0700
Organization SubpartNo
Authorized OfficialJeffery P KohlitzChief Financial Officer · (248) 581-5930
Enumeration DateJune 7, 2006
Last NPPES UpdateOctober 26, 20163 updates tracked since enumeration
✔ NPI 1063452233 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
4717 SAINT ANTOINE ST, Detroit, MI 48201
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Other Names 1

Doing Business AsWayne State University Physician Group

Other Identifiers 8

Other0H22869MI · Bcbsm Group Number
Other0P32140MI · Medicare Group # - Od
Medicare NSC5717980003MI
Medicare PIN0P32140MI
Other23D1091632MI · Clia Waiver
Medicare NSC5717980008MI
Medicare NSC5717980001MI
Medicare NSC5717980005MI

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of Tennessee.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D2328918

Wayne State University · Detroit, MI
Active · expires Aug 18, 2027
CLIA Number23D2328918
Laboratory TypeResearch
Certificate Effective DateAugust 19, 2025
Certificate Expiration DateAugust 18, 2027
Laboratory DirectorStephen Farrow
Laboratory Phone(313) 399-5888
Laboratory LocationWayne State University4201 St Antoine Suite 4-H, Detroit, MI 48201
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 23D1004406

Wayne State University Physician Group · Detroit, MI
Active · expires Sep 25, 2026
CLIA Number23D1004406
Laboratory TypePhysician Office
Certificate Effective DateSeptember 26, 2024
Certificate Expiration DateSeptember 25, 2026
Laboratory DirectorAlireza Amirsadri
Laboratory Phone(313) 993-6732
Laboratory LocationWayne State University Physician Group3901 Chrysler Service Drive, Detroit, MI 48201
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. HASSAN ALI TOKKO MD
Ophthalmology
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Wayne County (313) 577-7614
WILLIAM ROBERT LUCAS JR. MD
Ophthalmology
4717 SAINT ANTOINE ST, KRESGE EYE INSTITUTE
DETROIT, MI 48201
Wayne County (313) 577-8900
TUBA SOHAIL MIRZA DO
Ophthalmology
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Wayne County (313) 577-8900
PRADEEPA YOGANATHAN MD
Ophthalmology
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Wayne County (313) 577-8932
MARYAM ASHRAFKHORASANI
Ophthalmology
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Wayne County (313) 577-8900
NIKITA KAUR BHANGU MD
Student in an Organized Health Care Education/Training Program
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Wayne County (313) 745-5146
CLAIRE SIMONS MD
Student in an Organized Health Care Education/Training Program
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Wayne County (313) 577-8900
CHRISTOPHER DAVIS MD
Ophthalmology
4717 SAINT ANTOINE ST
DETROIT, MI 48201
Wayne County (313) 577-8900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is University Physician Group's NPI number?

The NPI number for University Physician Group is 1063452233. It was assigned to this organization in the NPPES registry on June 7, 2006. The provider is doing business as Wayne State University Physician Group.

Where is University Physician Group located?

University Physician Group is located at 4717 Saint Antoine St, Detroit, MI 48201. The listed phone number is (313) 577-8900.

What is University Physician Group's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Does University Physician Group hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does University Physician Group accept?

Health plans from BlueCross BlueShield of Tennessee list University Physician Group as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for University Physician Group was last updated on October 26, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.