Michigan Dermatology Center, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4301083995 Issued in MI

Legal business name

MICHIGAN DERMATOLOGY CENTER, PLLC

Practice address

38865 Dequindre Rd
Suite #104
Troy, MI 48083-6812

Phone

(248) 743-9330

Fax

(248) 743-9332

NPI assigned

Feb 7, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Farah Katherine Malick, M.D.NPI 1891819801

Title

Physician

Phone

(248) 743-9330

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

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

• Farah Katherine Malick, M.D.

  • Dermatology Physician
  • Troy, MI
  • NPI 1891819801
  Medicare reassignment NPD Authorized official
• George Paul Malick, MD

  • Dermatology Physician
  • Troy, MI
  • NPI 1750480869
  NPD (past)

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

{
    "created_epoch": "1328572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1649542689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38865 DEQUINDRE RD",
            "address_2": "SUITE #104",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480836812",
            "telephone_number": "248-743-9330",
            "fax_number": "248-743-9332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38865 DEQUINDRE RD",
            "address_2": "SUITE #104",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480836812",
            "telephone_number": "248-743-9330",
            "fax_number": "248-743-9332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN DERMATOLOGY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-07",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "MALICK",
        "authorized_official_first_name": "FARAH",
        "authorized_official_middle_name": "KATHERINE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "248-743-9330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301083995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; 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.