Active NPI
Dermatology Specialists of Canton, PLLC
- Dermatology Physician
- Canton, MI
National Provider Identifier
1003069014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 4301067985
- Legal business name
- DERMATOLOGY SPECIALISTS OF CANTON, PLLC
- Practice address
- 285 N Lilley Rd
Canton, MI 48187-3907 - Phone
- (734) 495-1506
- Fax
- (734) 495-1780
- NPI assigned
- Nov 4, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Iltefat H. Hamzavi, M.D.
- Title
- President
- Phone
- (734) 495-1506
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 4301067985 | MI | Primary |
Addresses
Primary practice location
285 N Lilley Rd
Canton, MI 48187-3907
Mailing address
43151 Dalcoma Drive
Suite 6
Clinton Township, MI 48038
Phone (586) 286-8720
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DO8072 | Other | MI | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090330000584 | MI | Part B Supplier - Clinic/Group Practice | 6507923976 |
Receives reassigned benefits from 24 practitioners Practice locations: Canton, MI; Livonia, MI |
National Provider Directory
National Provider DirectoryLocations
5958 N Canton Center Rd
Ste 700
Canton, MI 48187
Phone (734) 254-9500
285 N Lilley Rd
Canton, MI 48187
Phone (734) 495-1506
39000 7 Mile Rd
Ste 2900
Livonia, MI 48152
Phone (734) 884-6400
Practitioners & affiliated clinicians
Practitioners 25
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- MOHS-Micrographic Surgery Physician
- Canton, MI
- NPI 1952565897
Dermatology, MI
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225756800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1300147200000",
"number": "1003069014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43151 DALCOMA DRIVE",
"address_2": "SUITE 6",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "48038",
"telephone_number": "586-286-8720",
"fax_number": "866-790-6803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "285 N LILLEY RD",
"city": "CANTON",
"state": "MI",
"postal_code": "481873907",
"telephone_number": "734-495-1506",
"fax_number": "734-495-1780"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DERMATOLOGY SPECIALISTS OF CANTON, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-11-04",
"last_updated": "2011-03-15",
"status": "A",
"authorized_official_last_name": "HAMZAVI",
"authorized_official_first_name": "ILTEFAT",
"authorized_official_middle_name": "H.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "734-495-1506",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "MI",
"license": "4301067985",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DO8072",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.