CONCIERGE DERMATOLOGY & SKIN SURGERY CENTER (NPI# 1417442898) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417442898 |
| Entity Type | Organization |
| Organization Name | CONCIERGE DERMATOLOGY & SKIN SURGERY CENTER |
| Practice Address |
500 Campus Dr Hancock MI 49930 |
| Mailing Address |
540 S Lakeshore Blvd Unit 34 Marquette MI 49855-4631 |
| Practice Telephone | 9063627546 |
| Practice Fax Number | 4132698079 |
| Mailing Telephone | 7088339990 |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2018-10-31 |
| Authorized Official Name | MERCY A ODUEYUNGBO (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 9063627546 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
MI | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1500 Sandpoint Rd, Munising, MI 498621406 | 7098339990 | |
| 710 S Lincoln Rd, Escanaba, MI 498291292 | 9063627546 | 4132698079 |
| 18341 Us Highway 41, Lanse, MI 499468024 | 9063627546 | 4132698079 |
| Street Address |
500 CAMPUS DR |
| City | HANCOCK |
| State | MI |
| Zip Code | 49930 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215931068 | Portage Health Inc | Emergency Medicine | 500 Campus Dr, Hancock, MI 49930-1569 | 2005-06-09 |
| 1376182931 | Melissa Sue Meier | Nurse Practitioner | 500 Campus Dr, Hancock, MI 49930-1452 | 2019-12-31 |
| 1336786078 | Jeremy Michael Nicoski | Nurse Anesthetist, Certified Registered | 500 Campus Dr, Hancock, MI 49930-1452 | 2019-12-02 |
| 1548805005 | Shana Louise Roth | Dietitian, Registered | 500 Campus Dr, Hancock, MI 49930-1452 | 2019-11-08 |
| 1902365752 | Natalie Sloan Hupp | Physical Therapist | 500 Campus Dr, Hancock, MI 49930-1452 | 2019-03-19 |
| 1891267571 | Jenny Dice | Pharmacist | 500 Campus Dr, Hancock, MI 49930-1452 | 2018-12-19 |
| 1700354149 | Jessie Rae Salo | Nurse Practitioner | 500 Campus Dr, Hancock, MI 49930-1452 | 2018-11-04 |
| 1154806206 | Brittany Andrianna Wadaga | Registered Nurse | 500 Campus Dr, Hancock, MI 49930-1452 | 2018-09-25 |
| 1306343918 | Stephanie Bustos | Physical Therapist | 500 Campus Dr, Hancock, MI 49930-1452 | 2018-04-10 |
| 1477057230 | Amanda Kilpela | Speech-Language Pathologist | 500 Campus Dr, Hancock, MI 49930-1452 | 2018-03-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437627643 | Karen Byrnes | Registered Nurse | Hancock Va Cboc, 787 Market St. Suite 9, Hancock, MI 49930 | 2018-11-06 |
| 1881117562 | Angelica Monique Nunez | Specialist/Technologist | 601 Quincy St, Hancock, MI 49930 | 2017-07-25 |
| 1831581164 | Superior Prosthetics and Orthotics | Prosthetic/Orthotic Supplier | 20075 Third Street, Hancock, MI 49930 | 2015-02-24 |
| 1861703258 | Superior Smiles | Dentist | 1550 West Quincy St, Hancock, MI 49930 | 2010-06-30 |
| 1164633780 | Kathryn Mary Salmi | Counselor | 100 Quincy Street, Hancock, MI 49930 | 2007-05-25 |
| 1093828535 | Mary Katherine Van Camp | Social Worker | 787 Market St., Suites 9 & 10, Hancock, MI 49930 | 2006-08-17 |
| 1083627392 | Kim Kathleen Green | Social Worker | 787 Market Street, Hancock, MI 49930 | 2006-08-15 |
| 1346257672 | James William Sarazin | Dentist | 528 Quincy Street, Hancock, MI 49930 | 2006-08-01 |
| 1114951829 | Patricia J Tikkanen | Social Worker | 200 Michigan St Ste 321, Hancock, MI 49930 | 2006-07-10 |
| 1487639829 | Thomas Collins | Social Worker | 920 Water Street, Hancock, MI 49930 | 2005-12-08 |
| Find all providers in zip 49930 | ||||
| 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 |
| 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 |
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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.