Canton Dermatology, P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

DB032249 Issued in MI

Legal business name

CANTON DERMATOLOGY, P.C.

Practice address

8584 N Canton Center Rd
Canton, MI 48187-1310

Phone

(734) 455-4917

NPI assigned

Mar 16, 2006

Organization subpart

No

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

Authorized official

Name

Sue Mark

Title

Medical Biller

Phone

(734) 455-4917

Specialties & licenses 1

Addresses

Other identifiers 10

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1013986645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8584 N CANTON CENTER RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481871310",
            "telephone_number": "734-455-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8584 N CANTON CENTER RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481871310",
            "telephone_number": "734-455-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-16",
        "last_updated": "2008-02-15",
        "status": "A",
        "authorized_official_last_name": "MARK",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "MEDICAL BILLER",
        "authorized_official_telephone_number": "734-455-4917"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "DB032249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "B5020",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "C2791",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "101256",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2363389001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4072568",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4139614",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3899973001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "64889B",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "102494",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "64889A",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.