NPIMap

Organization Active NPI

Family Dermatology Center, P.C.

  • Dermatology Physician
  • Southfield, MI
National Provider Identifier
1073792917
Registry record updated Oct 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
4301038363 Issued in MI
Legal business name
FAMILY DERMATOLOGY CENTER, P.C.
Practice address
20555 W. 12 Mile Rd
Southfield, MI 48076
Phone
(248) 354-9595
Fax
(248) 354-9598
NPI assigned
Oct 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2007

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

Authorized official

Name
Carol Prince, M.D.
Title
President
Phone
(248) 354-9595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 4301038363 MI Primary

Addresses

Primary practice location

20555 W. 12 Mile Rd
Southfield, MI 48076

Mailing address

P.O. Box 3532
Southfield, MI 48037
Phone (248) 354-9595

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193616000000",
    "number": "1073792917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 3532",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48037",
            "telephone_number": "248-354-9595",
            "fax_number": "248-354-9598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20555 W. 12 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48076",
            "telephone_number": "248-354-9595",
            "fax_number": "248-354-9598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DERMATOLOGY CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2007-10-29",
        "status": "A",
        "authorized_official_last_name": "PRINCE",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-354-9595",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301038363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; 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.