NPIMap

Organization Active NPI

Kalamazoo Dermatology, P.C.

Doing business as Kalamazoo Dermatology & Skin Cancer Center

  • Dermatology Physician
  • Portage, MI
National Provider Identifier
1073607925
Registry record updated Jan 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
KALAMAZOO DERMATOLOGY, P.C.
Doing business as
Kalamazoo Dermatology & Skin Cancer Center
Practice address
6100 Newport Rd
Ste 100
Portage, MI 49002-9235
Phone
(269) 343-4679
Fax
(269) 343-5929
NPI assigned
Oct 3, 2006
Last updated
Jan 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2015

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

Authorized official

Name
Lori Kollin
Title
Practice Manager
Phone
(269) 343-4679

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

6100 Newport Rd
Ste 100
Portage, MI 49002-9235

Mailing address

6100 Newport Rd
Ste 100
Portage, MI 49002-9235
Phone (269) 343-4679

Other identifiers 1

IdentifierTypeStateIssuer
CA7827OtherMIPTAN

Other names 1

  • KALAMAZOO DERMATOLOGY & SKIN CANCER CENTER Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1073607925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 NEWPORT RD",
            "address_2": "STE 100",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490029235",
            "telephone_number": "269-343-4679",
            "fax_number": "269-343-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 NEWPORT RD",
            "address_2": "STE 100",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490029235",
            "telephone_number": "269-343-4679",
            "fax_number": "269-343-5929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALAMAZOO DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "KOLLIN",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "269-343-4679"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "CA7827",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KALAMAZOO DERMATOLOGY & SKIN CANCER CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; 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.