Nicole M Bossenbroek (NPI# 1619909611, PAC ID# 1254344567) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1619909611 |
| PAC ID by PECOS | 1254344567 |
| Professional Enrollment ID | I20070323000009 |
| Full Name | Nicole M Bossenbroek |
| Organization Legal Name | LAKESHORE DERM AND LASER CENTER PLC |
| Address |
6225 Prairie St Norton Shores MI 49444-7831 |
| Phone Number | 2317989500 |
| Gender | F |
| Credential | MD |
| Medical School | MEDICAL COLLEGE OF WISCONSIN |
| Graduation Year | 2002 |
| Primary Specialty | DERMATOLOGY |
| Secondary Specialties | PATHOLOGY |
| Group Practice PAC ID | 5799793006 |
| Number of Group Practice Members | 8 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 230046 | UNIVERSITY OF MICHIGAN HEALTH SYSTEM |
| 230059 | MERCY HEALTH SAINT MARY'S |
| Address | Phone | Organization |
|---|---|---|
| 6225 Prairie St, Norton Shores, MI 49444-7831 | 2317989500 | LAKESHORE DERM AND LASER CENTER PLC |
| Organization Legal Name | LAKESHORE DERM AND LASER CENTER PLC |
| Physicians | 8 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Katherine L Foster | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Timothy S Wang | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Kristen N Richards | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Julie M Murray Dull | Physician Assistant | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Jason Barrett Van Ittersum | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Jennifer L Vis | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Robert A Gielczyk | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Street Address |
6225 PRAIRIE ST |
| City | NORTON SHORES |
| State | MI |
| Zip | 49444-7831 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Katherine L Foster | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Timothy S Wang | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Kristen N Richards | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Julie M Murray Dull | Physician Assistant | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Jason Barrett Van Ittersum | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Jennifer L Vis | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Robert A Gielczyk | Dermatology | Lakeshore Derm and Laser Center Plc | 6225 Prairie St, Norton Shores, MI 49444-7831 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Katie Vanheck | Certified Nurse Midwife (cnm) | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Frank Remington Sprague | Internal Medicine | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Timothy E Kval | Family Medicine | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Beth Ann Stille | Nurse Practitioner | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Racquel M Brockington | Family Medicine | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Mariela A Rich | Certified Nurse Midwife (cnm) | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Gaye L Paget | Physician Assistant | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Abigail M Rienstra | Nurse Practitioner | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Margaret Elizabeth R Wolter | Nurse Practitioner | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Traci L Jones | Nurse Practitioner | Mgh Family Health Center | 2201 S Getty St, Muskegon, MI 49444-1207 |
| Find all physicians in zip 49444 | |||
| City | NORTON SHORES |
| Zip Code | 49444 |
| Specialty | DERMATOLOGY |
| City + Specialty | NORTON SHORES + DERMATOLOGY |
Please comment or provide details below to improve the information on Nicole M Bossenbroek.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.