Clarkston Dermatology & Vein Center PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

5101014699 Issued in MI

Legal business name

CLARKSTON DERMATOLOGY & VEIN CENTER PLLC

Practice address

5701 Bow Pointe Dr
Suite 215
Clarkston, MI 48346-3198

Phone

(248) 620-3376

Fax

(248) 620-3379

NPI assigned

Feb 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Wendy L McFalda, D.O.

Title

Member

Phone

(248) 620-3376

Specialties & licenses 1

Addresses

Other identifiers 4

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433721600000",
    "number": "1003943408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 BOW POINTE DR",
            "address_2": "SUITE 215",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483463198",
            "telephone_number": "248-620-3376",
            "fax_number": "248-620-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 BOW POINTE DR",
            "address_2": "SUITE 215",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483463198",
            "telephone_number": "248-620-3376",
            "fax_number": "248-620-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSTON DERMATOLOGY & VEIN CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2015-06-08",
        "status": "A",
        "authorized_official_last_name": "MCFALDA",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "248-620-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5101014699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "0756301335",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PLUS BLUE",
            "identifier": "0P14750",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DD8092",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "0756301335",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clarkston Chiropractic Sports & Wellness LLC
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• Clarkston Dental Care
• Clarkston Family Dental
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• Clarkston Health Center
• Clarkston Internal Medicine, P.C.
• Clarkston Lakes Family Medicine LLC

• Dermatology Physician in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.