The Skin Cancer and Dermatology Center PLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

4301104387 Issued in MI

Legal business name

THE SKIN CANCER AND DERMATOLOGY CENTER PLC

Practice address

5199 N Royal Dr
Traverse City, MI 49684-9201

Phone

(231) 486-0230

Fax

(231) 525-2062

NPI assigned

May 31, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Laurel Leithauser, MDNPI 1912132945

Title

Owner and Medical Director

Phone

(231) 632-8456

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 5

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

• Laurel Aeriel Leithauser, M.D.

  • MOHS-Micrographic Surgery Physician
  • Traverse City, MI
  • NPI 1912132945
  Medicare reassignment Care Compare group NPD Authorized official
• Kari Jo Nothstine, FNP-C

  • Family Nurse Practitioner
  • Traverse City, MI
  • NPI 1598485229
  Medicare reassignment Care Compare group NPD
• Casey Thomas Weitzel, PA-C

  • Physician Assistant
  • Charlevoix, MI
  • NPI 1811658347
  Medicare reassignment Care Compare group NPD
• Rachel M Zenner, FNP

  • Family Nurse Practitioner
  • Kalkaska, MI
  • NPI 1336794114
  Medicare reassignment Care Compare group NPD
• Angela Pailthorpe, PA-C

  • Physician Assistant
  • Traverse City, MI
  • NPI 1083358436
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1346732880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5199 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849201",
            "telephone_number": "231-632-8456",
            "fax_number": "231-525-2062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5199 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849201",
            "telephone_number": "231-486-0230",
            "fax_number": "231-525-2062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SKIN CANCER AND DERMATOLOGY CENTER PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-31",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "LEITHAUSER",
        "authorized_official_first_name": "LAUREL",
        "authorized_official_title_or_position": "OWNER AND MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "231-632-8456",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MI",
            "license": "4301104387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Maple Clinic, Inc.
• The Northern Lights Counseling Collective PLLC
• The Nurturing Space Counseling, PLLC
• The Prescription Shop of Traverse City East Inc
• The Resiliency Therapy Center, PLLC
• The Studio Art Therapy & Counseling
• The Surgery Center
• The Surgery Center
• Carissa Mae Thelen, OTRL
• Therapy North LLC

• MOHS-Micrographic Surgery Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• MOHS-Micrographic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.