Lisa a Manz Dulac MD & Associates PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LISA A MANZ DULAC MD & ASSOCIATES PC

Doing business as

Eastside Dermatology PC

Practice address

20030 Mack Ave
Grosse Pointe Woods, MI 48236-2323

Phone

(313) 884-3380

Fax

(313) 884-9756

NPI assigned

Mar 22, 2006

Last updated

Jan 3, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa A Manz-Dulac, MDNPI 1871552497

Title

Owner

Phone

(313) 884-3380

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Eastside Dermatology PC Doing business as

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 7

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.

• Lisa Allyn Manz Dulac, MD

  • Specialist
  • Grosse Pointe Woods, MI
  • NPI 1871552497
  Medicare reassignment Care Compare group Authorized official
• Danielle Bosscher, FNP-C

  • Family Nurse Practitioner
  • Birmingham, MI
  • NPI 1871040154
  Medicare reassignment Care Compare group NPD
• Natalia Filipof

  • Specialist
  • Grosse Pointe Woods, MI
  • NPI 1245340975
  Medicare reassignment Care Compare group NPD
• Douglas Michael Piernick II, M.D.

  • MOHS-Micrographic Surgery Physician
  • Grosse Pointe Woods, MI
  • NPI 1487053575
  Medicare reassignment Care Compare group NPD
• Kendall Morgan Rabaut, FNP-C

  • Nurse Practitioner
  • Grosse Pointe Woods, MI
  • NPI 1093545857
  Medicare reassignment Care Compare group NPD
• Lindsey Aileen Renkiewicz

  • Physician Assistant
  • Davisburg, MI
  • NPI 1588360242
  Medicare reassignment Care Compare group
• Emily O'Rourke

  • Physician Assistant
  • Lenox Township, MI
  • NPI 1548640709
  Medicare reassignment

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325548800000",
    "number": "1326007956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20030 MACK AVE",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362323",
            "telephone_number": "313-884-3380",
            "fax_number": "313-884-9756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20030 MACK AVE",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362323",
            "telephone_number": "313-884-3380",
            "fax_number": "313-884-9756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA A MANZ DULAC MD & ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-22",
        "last_updated": "2012-01-03",
        "status": "A",
        "authorized_official_last_name": "MANZ-DULAC",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-884-3380",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "23D0916007",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI GROUP NUMBER",
            "identifier": "070H24887",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Dermatology PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert Jay Leonard, M.D.
• Claude Charles Lerose Jr., D.D.S.
• Tihara Lewis
• Ginette Alicia Lezotte, AUD
• Michael Linebaugh, DDS
• Lloyd and Boccaccio MD PC (St Clair Surgical Specialists)
• Adonis N Lorenzana, MD
• Louie Behavioral Insights
• Kimberly Noel Lowe
• Sony Lukose

• Specialist in Grosse Pointe Woods, MI
• Providers in Grosse Pointe Woods, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2012; 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.