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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

JERI KEDZIERSKI M.D.
NPI 1093769432
Specialist in Plymouth, MI

Active since May 20, 2006Opted out of Medicare · through Jul 18, 2027
990 W ANN ARBOR TRL, PLYMOUTH, MI 48170(734) 414-1099(734) 414-1065 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jeri Kedzierski M.d. NPPES

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

JERI KEDZIERSKI M.D. (NPI 1093769432) is an individual specialist in Plymouth, Michigan, licensed in Michigan (4301066828) and active in the NPI registry since May 2006. She has opted out of Medicare through July 18, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1093769432
Entity TypeIndividualFemale
Primary Taxonomy174400000X
Provider Legal NameJERI KEDZIERSKICredential: M.D.
Location Address990 W ANN ARBOR TRLPlymouth, MI 48170-6204
Mailing Address990 W Ann Arbor TrlPlymouth, MI 48170-6204 · (734) 414-1099 · Fax (734) 414-1065
Phone(734) 414-1099
Fax(734) 414-1065
Sole ProprietorNo
Enumeration DateMay 20, 2006
Last NPPES UpdateJuly 13, 2026
✔ NPI 1093769432 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in MI · 4301066828
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
990 W ANN ARBOR TRL, Plymouth, MI 48170
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Other Identifiers 1

Other4301066828MI · License

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Jeri Kedzierski M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 18, 2013 through July 18, 2027.

Opt-Out Effective DateJuly 18, 2013
Opt-Out In Effect ThroughJuly 18, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

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.

MRS. CYNTHIA DENISE CULLER-JOHNSON MD
Internal Medicine
990 W ANN ARBOR TRL, SUITE 208
PLYMOUTH, MI 48170
Wayne County (734) 455-1200
DR. TARIN GITLIN M.D.
Pediatrics
990 W ANN ARBOR TRL, SUITE 210
PLYMOUTH, MI 48170
Wayne County (734) 455-4600
JAMES SANSONE M.D.
Pediatrics
990 W ANN ARBOR TRL, SUITE 210
PLYMOUTH, MI 48170
Wayne County (734) 455-4600
DR. LORRI VANDERROEST M.D.
Pediatrics
990 W ANN ARBOR TRL, SUITE 210
PLYMOUTH, MI 48170
Wayne County (734) 455-4600
ROBERT CHARLES URBANIC M.D.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
990 W ANN ARBOR TRL, SUITE 100
PLYMOUTH, MI 48170
Wayne County (734) 455-4200
IHA HEALTH SERVICES CORPORATION
Pediatrics
990 W ANN ARBOR TRL, SUITE 210
PLYMOUTH, MI 48170
Wayne County (734) 455-4600
DR. NORMAN GOVE M.D.
Obstetrics & Gynecology
990 W ANN ARBOR TRL, SUITE 302
PLYMOUTH, MI 48170
Wayne County (734) 414-1090
DR. PRAVEEN KUMAR MODI M.D
Internal Medicine
990 W ANN ARBOR TRL, SUITE 102
PLYMOUTH, MI 48170
Wayne County (734) 414-1088

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 Jeri Kedzierski's NPI number?

The NPI number for Jeri Kedzierski is 1093769432. It was assigned to this individual provider in the NPPES registry on May 20, 2006.

Where is Jeri Kedzierski located?

Jeri Kedzierski practices at 990 W Ann Arbor Trl, Plymouth, MI 48170. The listed phone number is (734) 414-1099.

What is Jeri Kedzierski's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Jeri Kedzierski enrolled in Medicare?

No. Jeri Kedzierski has opted out of Medicare through July 18, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Jeri Kedzierski was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 days 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.