NPIMap

Organization Active NPI

Manistee Dermatology

  • Legal Medicine
  • Manistee, MI
National Provider Identifier
1093913204
Registry record updated Feb 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
4301086785 Issued in MI
Legal business name
MANISTEE DERMATOLOGY
Practice address
1293 E Parkdale Ave
Suite 2500
Manistee, MI 49660-8904
Phone
(231) 398-1700
Fax
(231) 398-1709
NPI assigned
Jul 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2012

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

Authorized official

Name
Dr. Stephanie Dawn Neider, MDNPI 1386678381
Title
Doctor
Phone
(231) 398-1700

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193400000X SINGLE SPECIALTY GROUP 173000000X 4301086785 MI Primary

Addresses

Primary practice location

1293 E Parkdale Ave
Suite 2500
Manistee, MI 49660-8904

Mailing address

2138 Reliable Pkwy
Chicago, IL 60686-0001
Phone (231) 398-1700

Other identifiers 1

IdentifierTypeStateIssuer
104819846MedicaidMI

National Provider Directory

National Provider Directory

Locations

2138 Reliable Pkwy
Chicago, IL 60686

Practitioners & affiliated clinicians

Practitioners 2

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": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328832000000",
    "number": "1093913204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2138 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860001",
            "telephone_number": "231-398-1700",
            "fax_number": "231-398-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1293 E PARKDALE AVE",
            "address_2": "SUITE 2500",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496608904",
            "telephone_number": "231-398-1700",
            "fax_number": "231-398-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANISTEE DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2012-02-10",
        "status": "A",
        "authorized_official_last_name": "NEIDER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "231-398-1700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "MI",
            "license": "4301086785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104819846",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manistee, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; 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.