NORTHWESTERN MICHIGAN DERMATOLOGY (NPI# 1346457488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346457488 |
| Entity Type | Organization |
| Organization Name | NORTHWESTERN MICHIGAN DERMATOLOGY |
| Practice Address |
550 Munson Ave Suite 200 Traverse City MI 49686-3580 |
| Practice Telephone | 2319358717 |
| Practice Fax Number | 2319359230 |
| Mailing Telephone | 2319358717 |
| Mailing Fax Number | 2319359230 |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SOUMIT SHAM PENDHARKAR (OFFICE MANAGER) |
| Authorized Official Telephone | 2319358717 |
| Authorized Official Credential | MHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 3347473 | 05 | |
| MI | NPI | 1962511097 | 01 |
| MI | 1997138 | 05 | |
| MI | NPI | 1285743393 | 01 |
| MI | NPI NUMBER | 1770692873 | 01 |
| MI | NPI | 1437268661 | 01 |
| MI | MI LICENSE | 4301063462 | 01 |
| MI | MI LICENSE | 4301067697 | 01 |
| MI | MI LICENSE | 4301077553 | 01 |
| MI | MICHIGAN LICENSE | 4301406284 | 01 |
| MI | 4317989 | 05 |
| Street Address |
550 MUNSON AVE SUITE 200 |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49686-3580 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205839131 | William H. George | Internal Medicine | 550 Munson Ave, Traverse City, MI 49686 | 2005-05-24 |
| 1265054936 | Erynne Louise Russell | Speech-Language Pathologist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2020-05-15 |
| 1821624545 | Susan Carol Spencer | Speech-Language Pathologist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2020-03-13 |
| 1346807617 | Mary Priestly | Physician Assistant | 550 Munson Ave, Traverse City, MI 49686-3580 | 2019-05-22 |
| 1194380493 | Kimberly A Chandler | Health Educator | 550 Munson Ave, Traverse City, MI 49686-3580 | 2019-05-02 |
| 1942770946 | Caroline Kiley | Physical Therapist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-12-03 |
| 1851861850 | Grace Blankenhagen | Physical Therapist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-12-03 |
| 1316429863 | Elizabeth Marie Teklinski | Counselor | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-08-31 |
| 1326544230 | Kaitlyn Troutman | Nurse Practitioner | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-04-02 |
| 1598267254 | Teresa Lynn Hearne | Physical Therapist | 550 Munson Ave, Traverse City, MI 49686-3580 | 2018-03-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245877208 | Jessica Marie Glowacki | Behavior Technician | 935 Hemlock St, Traverse City, MI 49686 | 2019-12-09 |
| 1568011542 | Joanne Kressley | Technician | 1693 Maylane Apt. 104, Traverse City, MI 49686 | 2019-09-11 |
| 1194283846 | Pace North | PACE Provider Organization | 2325 Garfield Road N., Traverse City, MI 49686 | 2019-03-12 |
| 1245749225 | Margaret Anne Goss | Speech-Language Pathologist | 1105 E. Eighth Street, Traverse City, MI 49686 | 2017-09-22 |
| 1467981811 | Joan Joyce Shirilla | Social Worker | 2124 Twin Eagles Dr, Traverse City, MI 49686 | 2017-06-08 |
| 1770028763 | Rehab and Mobility Systems, LLC | Durable Medical Equipment & Medical Supplies | 707 Parsons, Traverse City, MI 49686 | 2016-12-29 |
| 1629511316 | Kaitlyn Grangood | Social Worker | 415 Munson Avenue, Ste 101, Traverse City, MI 49686 | 2016-11-29 |
| 1811441132 | Jeffrey D Goodwin | Counselor | 430 Fair St., Traverse City, MI 49686 | 2016-08-04 |
| 1053779918 | Thomas Osborne | Counselor | 2014 Phelps Rd., Traverse City, MI 49686 | 2016-02-08 |
| 1982079588 | Marsha Lynne Dallas | Counselor | 2240 South Airport Road, Traverse City, MI 49686 | 2015-12-08 |
| Find all providers in zip 49686 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1912132945 | Laurel Aeriel Leithauser | Dermatology | 3643 W Front St Ste A, Traverse City, MI 49684-7760 | 2009-05-19 |
| 1962511097 | Mark R. Pomaranski | Dermatology | 550 Munson Ave, Suite 200, Traverse City, MI 49686 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407309560 | St Joseph Dermatology and Vein Clinic Pllc | Dermatology | 2500 Niles Rd Ste 10a, Saint Joseph, MI 49085-3272 | 2016-07-25 |
| 1003290750 | El Tal Md PC | Dermatology | 555 Midtowne St Ne Ste 301, Grand Rapids, MI 49503-5729 | 2015-07-13 |
| 1912347923 | Forefront Dermatology, S.c. | Dermatology | 4362 Cascade Road, Suite 206, Grand Rapids, MI 49546 | 2013-07-05 |
| 1699003699 | Robert G Lee P C | Dermatology | 200 S Wenona St Ste G96, Bay City, MI 48706-8831 | 2009-12-02 |
| 1265645535 | Academic Dermatology & Cosmetic Surgery Center, Pllc | Dermatology | 50182 Schoenherr Road, Shelby Twp., MI 48315 | 2007-05-07 |
| 1649300880 | Skin Care Physicians PC | Dermatology | 2026 N Beech Daly Rd, Dearborn Heights, MI 48127-3405 | 2007-03-06 |
| 1437133097 | Kent Jerome Krach | Dermatology | 43900 Garfield Road, Suite 100, Clinton Township, MI 48038 | 2005-12-06 |
| 1134124217 | Montgomery O Gillard | Dermatology | 4990 W Clark Rd, Building A, Suite 200, Ypsilanti, MI 48197-1149 | 2005-06-16 |
| 1366906364 | Tru North Dermatology | Dermatology | 315 Oakgrove St, Manistee, MI 49660-1176 | 2019-01-24 |
| 1417442898 | Concierge Dermatology & Skin Surgery Center | Dermatology | 500 Campus Dr, Hancock, MI 49930 | 2018-06-27 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49686 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.