NPIMap

Organization Active NPI

Academic Dermatology & Cosmetic Surgery Center, PLLC

  • Dermatology Physician
  • Shelby TWP., MI
National Provider Identifier
1265645535
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
4301058522 Issued in MI
Legal business name
ACADEMIC DERMATOLOGY & COSMETIC SURGERY CENTER, PLLC
Practice address
50182 Schoenherr Road
Shelby TWP., MI 48315
Phone
(586) 997-9700
Fax
(586) 997-9738
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Authorized official

Name
Dr. Brian G Sandler, MDNPI 1063493096
Title
Owner
Phone
(586) 997-9700

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 4301058522 MI Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X 4301058522 MI

Addresses

Primary practice location

50182 Schoenherr Road
Shelby TWP., MI 48315

Mailing address

51189 Shelby Pkwy
Shelby TWP, MI 48315-1786
Phone (586) 997-9700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070928000633 MI Part B Supplier - Clinic/Group Practice 0941395404 Receives reassigned benefits from 3 practitioners
Practice locations: Shelby Township, MI

National Provider Directory

National Provider Directory

Locations

51221 Schoenherr Rd
Ste 201
Shelby Township, MI 48315
Phone (586) 254-3545

50182 Schoenherr Rd
Shelby Township, MI 48315
Phone (586) 522-4256

51189 Shelby Pkwy
Shelby Township, MI 48315
Phone (586) 997-9700

Practitioners & affiliated clinicians

Practitioners 3

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": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1265645535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51189 SHELBY PKWY",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483151786",
            "telephone_number": "586-997-9700",
            "fax_number": "586-997-9738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50182 SCHOENHERR ROAD",
            "city": "SHELBY TWP.",
            "state": "MI",
            "postal_code": "48315",
            "telephone_number": "586-997-9700",
            "fax_number": "586-997-9738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMIC DERMATOLOGY & COSMETIC SURGERY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "SANDLER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-997-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301058522",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MI",
            "license": "4301058522",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby TWP., MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.