NPIMap

Organization Active NPI

Blue Skies Dermatology

  • Dermatology Physician
  • Saint Clair Shores, MI
National Provider Identifier
1104090794
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
012868 Issued in MI
Legal business name
BLUE SKIES DERMATOLOGY
Practice address
29167 Jefferson Ave
Suite B
Saint Clair Shores, MI 48081-1331
Phone
(586) 296-1301
Fax
(586) 296-1304
NPI assigned
Apr 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Authorized official

Name
Dr. Colene Marie Calo, D.O.NPI 1396790317
Title
Physician
Phone
(586) 296-1301

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
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 012868 MI Primary

Addresses

Primary practice location

29167 Jefferson Ave
Suite B
Saint Clair Shores, MI 48081-1331

Mailing address

29167 Jefferson Ave
Suite B
Saint Clair Shores, MI 48081-1331
Phone (586) 296-1301

National Provider Directory

National Provider Directory

Locations

29167 Jefferson Ave
Ste B
Saint Clair Shores, MI 48081
Phone (586) 296-1301

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1104090794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29167 JEFFERSON AVE",
            "address_2": "SUITE B",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811331",
            "telephone_number": "586-296-1301",
            "fax_number": "586-296-1304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29167 JEFFERSON AVE",
            "address_2": "SUITE B",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811331",
            "telephone_number": "586-296-1301",
            "fax_number": "586-296-1304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE SKIES DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "CALO",
        "authorized_official_first_name": "COLENE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "586-296-1301",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "012868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.