NPIMap

Organization Active NPI

Dermatology Specialists of Canton, PLLC

  • Dermatology Physician
  • Canton, MI
National Provider Identifier
1003069014
Registry record updated Mar 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
4301067985 Issued in MI
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
Last updated
Mar 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2011

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.NPI 1538117866
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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
DO8072OtherMIRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Directory

Locations

285 N Lilley Rd
Canton, MI 48187
Phone (734) 495-1506

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, and the practitioner matching its NPPES authorized official.

View all 25

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": "",
            "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.

Verify at the official NPI Registry.