NPIMap

Organization Active NPI

Dermatology & Phototherapy Center of Brighton, PLC

  • Dermatology Physician
  • Brighton, MI
National Provider Identifier
1659624591
Registry record updated Apr 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY & PHOTOTHERAPY CENTER OF BRIGHTON, PLC
Practice address
2305 Genoa Business Park Dr
Brighton, MI 48114-7004
Phone
(810) 355-4300
Fax
(586) 286-8723
NPI assigned
Oct 16, 2012
Last updated
Apr 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2013

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

Authorized official

Name
Dr. Iltefat Hamzavi, M.D.NPI 1538117866
Title
Member
Phone
(586) 286-8720

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

2305 Genoa Business Park Dr
Brighton, MI 48114-7004

Mailing address

43151 Dalcoma Dr
Clinton Township, MI 48038-6306
Phone (586) 286-8720

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130510000391 MI Part B Supplier - Clinic/Group Practice 7618114695 Receives reassigned benefits from 17 practitioners
Practice locations: Brighton, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366243200000",
    "number": "1659624591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43151 DALCOMA DR",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480386306",
            "telephone_number": "586-286-8720",
            "fax_number": "586-286-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 GENOA BUSINESS PARK DR",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481147004",
            "telephone_number": "810-355-4300",
            "fax_number": "586-286-8723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & PHOTOTHERAPY CENTER OF BRIGHTON, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-16",
        "last_updated": "2013-04-18",
        "status": "A",
        "authorized_official_last_name": "HAMZAVI",
        "authorized_official_first_name": "ILTEFAT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "586-286-8720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; 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.