IAN ALBERT ETHEART DO
NPI 1467035188
Student in an Organized Health Care Education/Training Program in Mount Clemens, MI

Q: What is Ian Etheart's NPI number?

The NPI number for Ian Etheart is 1467035188. It was assigned to this individual provider in the NPPES registry on April 30, 2021.

Q: What is Ian Etheart's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Ian Etheart was last updated on April 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.

Active since April 30, 2021PECOS Enrolled

1000 HARRINGTON ST, MOUNT CLEMENS, MI 48043(586) 790-9003 Get Directions Write a Review

NPPES record last updated: April 30, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Ian Albert Etheart Do NPPES

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

IAN ALBERT ETHEART DO (NPI 1467035188) is an individual student in an organized health care education/training program in Mount Clemens, Michigan and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1467035188

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameIAN ALBERT ETHEARTCredential: DO

Location Address1000 HARRINGTON STMount Clemens, MI 48043-2920

Mailing Address1000 Harrington StMount Clemens, MI 48043-2920 · (586) 790-9003

Phone(586) 790-9003

Sole ProprietorNo

Enumeration DateApril 30, 2021

NPPES CertifiedApril 30, 2021

✔ NPI 1467035188 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1000 HARRINGTON ST, Mount Clemens, MI 48043

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ian Albert Etheart Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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.

LEMAR GARDEZI MD

Student in an Organized Health Care Education/Training Program