Organization Active NPI

Midwest Center for Dermatology & Pathology, PLLC

  • Dermatopathology Physician
  • Clinton Township, MI
National Provider Identifier
1003095084
Registry record updated Oct 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
Legal business name
MIDWEST CENTER FOR DERMATOLOGY & PATHOLOGY, PLLC
Practice address
43900 Garfield Rd
Suite 100
Clinton Township, MI 48038-1128
Phone
(586) 286-0112
Fax
(586) 286-2702
NPI assigned
Oct 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Altman, M.D.NPI 1205831005
Title
Director
Phone
(586) 574-2800

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X Primary
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

43900 Garfield Rd
Suite 100
Clinton Township, MI 48038-1128

Mailing address

43900 Garfield Rd
Suite 100
Clinton Township, MI 48038-1128
Phone (586) 286-0112

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080103000679 MI Part B Supplier - Clinic/Group Practice 0446330492 Receives reassigned benefits from 52 practitioners
Practice locations: Ypsilanti, MI; West Bloomfield, MI; Warren, MI; Shelby Township, MI; Saint Clair Shores, MI; Oxford, MI; Novi, MI; Commerce Township, MI…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0692358Midwest Center for Dermatology & Pathology - I & D43900 Garfield Road Suite 228, Clinton Township, MI 48038Provider-performed microscopySep 30, 2027
23D1076624Midwest Center for Dermatology & Pathology43900 Garfield Suite 210, Clinton Township, MI 48038AccreditationJun 23, 2028

National Provider Directory

National Provider Directory

Locations

43900 Garfield Rd
Ste 121
Clinton Twp, MI 48038
Phone (586) 228-3880

43900 Garfield Rd
Ste 228
Clinton Twp, MI 48038
Phone (586) 286-0112

43900 Garfield Rd
Ste 129
Clinton Twp, MI 48038
Phone (586) 228-2255

9640 Commerce Rd
Ste 100
Commerce Township, MI 48382
Phone (248) 482-2101

31275 Northwestern Hwy
Ste 40
Farmington Hills, MI 48334

31275 Northwestern Hwy
Ste 140
Farmington Hills, MI 48334
Phone (248) 538-0109

46325 W Twelve Mile Rd
Ste 370
Novi, MI 48377
Phone (248) 482-2103

72 S Washington St
Ste 206
Oxford, MI 48371
Phone (248) 620-3376

52873 Schoenherr Rd
Shelby Township, MI 48315
Phone (586) 566-6770

11900 E 12 Mile Rd
Ste 201
Warren, MI 48093
Phone (313) 574-2803

Practitioners & affiliated clinicians

Practitioners 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 64

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193356800000",
    "number": "1003095084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43900 GARFIELD RD",
            "address_2": "SUITE 100",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381128",
            "telephone_number": "586-286-0112",
            "fax_number": "586-286-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43900 GARFIELD RD",
            "address_2": "SUITE 100",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381128",
            "telephone_number": "586-286-0112",
            "fax_number": "586-286-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST CENTER FOR DERMATOLOGY & PATHOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-26",
        "last_updated": "2007-10-26",
        "status": "A",
        "authorized_official_last_name": "ALTMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "586-574-2800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.