Lake Michigan Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LAKE MICHIGAN DERMATOLOGY PLLC

Practice address

1148 Washington Ave Ste 20
Holland, MI 49423-7728

Phone

(616) 499-4844

Fax

(616) 499-4847

NPI assigned

Jul 10, 2022

Organization subpart

No

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

Authorized official

Name

Anthony Berger, MD MPHNPI 1508391160

Title

Manager, Owner

Phone

(616) 499-4844

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Anthony Peter Berger, MD

  • Dermatology Physician
  • Holland, MI
  • NPI 1508391160
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1657411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1235863978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1148 WASHINGTON AVE STE 20",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494237728",
            "telephone_number": "616-499-4844",
            "fax_number": "269-849-8708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1148 WASHINGTON AVE STE 20",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494237728",
            "telephone_number": "616-499-4844",
            "fax_number": "616-499-4847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MICHIGAN DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-10",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "BERGER",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "MANAGER, OWNER",
        "authorized_official_telephone_number": "616-499-4844",
        "authorized_official_credential": "MD MPH"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Lahaie, LLC
• Teresa Lynn Lahaie, LMSW
• Elizabeth Annmarie Lahrman, BCBA; M.ED.
• Janet Laing, LMSW, CAADC, CCS-M
• Lake Michigan Anesthesia Staffing LLC
• Lake Michigan Wellness PLLC
• Lakehsore Otolaryngology
• Lakeshore Allergy PC
• Lakeshore Area Radiation Oncology Center
• Lakeshore Eyecare Center PC

• Dermatology Physician in Holland, MI
• Providers in Holland, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.