IAN J DOMINGUEZ DO
NPI 1952097065
Student in an Organized Health Care Education/Training Program in Warren, MI

Q: What is Ian Dominguez's NPI number?

The NPI number for Ian Dominguez is 1952097065. It was assigned to this individual provider in the NPPES registry on April 12, 2023.

Q: What is Ian Dominguez'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 Dominguez was last updated on April 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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 12, 2023PECOS Enrolled

11885 E 12 MILE RD STE 300A, WARREN, MI 48093(586) 573-7470(586) 573-0850 Get Directions Write a Review

NPPES record last updated: April 12, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Ian J Dominguez Do NPPES

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

IAN J DOMINGUEZ DO (NPI 1952097065) is an individual student in an organized health care education/training program in Warren, Michigan and active in the NPI registry since April 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1952097065

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameIAN J DOMINGUEZCredential: DO

Location Address11885 E 12 MILE RD STE 300AWarren, MI 48093-3467

Mailing Address11885 E 12 Mile Rd Ste 300aWarren, MI 48093-3467 · (586) 573-7470 · Fax (586) 573-0850

Phone(586) 573-7470

Fax(586) 573-0850

Sole ProprietorYes

Enumeration DateApril 12, 2023

NPPES CertifiedApril 12, 2023

✔ NPI 1952097065 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.

11885 E 12 MILE RD STE 300A, Warren, MI 48093

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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 J Dominguez 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.

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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.

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