Organization Active NPI

Straits Area Dermatology Center PLC

  • Dermatology Physician
  • Cheboygan, MI
National Provider Identifier
1114726767
Registry record updated Aug 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
STRAITS AREA DERMATOLOGY CENTER PLC
Practice address
761 Lafayette Ave
Cheboygan, MI 49721-2117
Phone
(231) 420-2140
NPI assigned
Mar 7, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2025

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

Authorized official

Name
Emily Ptasnik, DONPI 1801470059
Title
Ceo/Owner
Phone
(989) 370-2448

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 Primary

Addresses

Primary practice location

761 Lafayette Ave
Cheboygan, MI 49721-2117

Mailing address

761 Lafayette Ave
Cheboygan, MI 49721-2117
Phone (231) 420-2140

Other names 1

  • STRAITS DERMATOLOGY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251007000758 MI Part B Supplier - Clinic/Group Practice 8527565605 Receives reassigned benefits from 2 practitioners
Practice locations: Cheboygan, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2330323Straits Area Dermatology Center PLC761 Lafayette Avenue, Cheboygan, MI 49721RegistrationNov 30, 2027

National Provider Directory

National Provider Directory

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": "1741305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754524800000",
    "number": "1114726767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 LAFAYETTE AVE",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497212117",
            "telephone_number": "231-420-2140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 LAFAYETTE AVE",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497212117",
            "telephone_number": "231-420-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRAITS AREA DERMATOLOGY CENTER PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-07",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A",
        "authorized_official_last_name": "PTASNIK",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "989-370-2448",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STRAITS DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "STRAITS DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cheboygan, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.