South Lyon Dermatology, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SOUTH LYON DERMATOLOGY, PC

Practice address

26036 Pontiac TRL
South Lyon, MI 48178-8050

Phone

(248) 479-2200

Fax

(248) 479-2682

NPI assigned

Apr 29, 2015

Organization subpart

No

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

Authorized official

Name

Angela M Clay, DONPI 1669609871

Title

Authorized Rep/Owner

Phone

(248) 479-2200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

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

• Angela Marie Clay, D.O.

  • Dermatology Physician
  • South Lyon, MI
  • NPI 1669609871
  Medicare reassignment Care Compare group NPD Authorized official
• Alexandrea T Bedirian, PA-C

  • Medical Physician Assistant
  • South Lyon, MI
  • NPI 1629735287
  Medicare reassignment Care Compare group
• Amanda M Rodriguez, PA-C

  • Physician Assistant
  • Jackson, MI
  • NPI 1326109208
  Medicare reassignment

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

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437004800000",
    "number": "1407233323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26036 PONTIAC TRL",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788050",
            "telephone_number": "248-479-2200",
            "fax_number": "248-479-2682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26036 PONTIAC TRL",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788050",
            "telephone_number": "248-479-2200",
            "fax_number": "248-479-2682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LYON DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-29",
        "last_updated": "2015-07-16",
        "status": "A",
        "authorized_official_last_name": "CLAY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "AUTHORIZED REP/OWNER",
        "authorized_official_telephone_number": "248-479-2200",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407233323",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth Smoot, AT, ATC
• Karen Smyte, LLMSW MS MFA
• Yvonne Marie Snyder, DDS
• South Lyon Chiropractic PLLC
• South Lyon Dental Group, P.L.C.
• South Lyon Family Docs PC
• South Lyon Family Physicians, PLLC
• South Lyon Foot & Ankle Specialists, P.C.
• South Lyon Orthodontics, PC
• South Lyon Pediatric Dentistry PLLC

• Dermatology Physician in South Lyon, MI
• Providers in South Lyon, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; 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.