Wolverine Dermatology, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4301084275 Issued in MI

Legal business name

WOLVERINE DERMATOLOGY, PC

Practice address

1673 Gezon Pkwy SW
Wyoming, MI 49519-9519

Phone

(616) 243-3376

Fax

(616) 243-3377

NPI assigned

Oct 25, 2017

Last updated

Feb 28, 2023By 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

Dr. Ryan Dale Freeland, MDNPI 1942265178

Title

Owner

Phone

(210) 632-0341

Specialties & licenses 1

Addresses

Other identifiers 2

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

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00325

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.

• Ryan Dale Freeland, MD

  • Dermatology Physician
  • Wyoming, MI
  • NPI 1942265178

  Multi-Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Jack A Dekkinga, MD

  • MOHS-Micrographic Surgery Physician
  • Wyoming, MI
  • NPI 1255365334

  Dermatology

  Medicare reassignment Care Compare group NPD
• Amber B Matthysse, MS PA-C

  • Physician Assistant
  • Wyoming, MI
  • NPI 1558455311
  Medicare reassignment Care Compare group
• Kurt Vanderveen, PA-C

  • Physician Assistant
  • Grandville, MI
  • NPI 1407941396
  Medicare reassignment Care Compare group
• Brandon William McNally, M.D.

  • Dermatopathology Physician
  • Grandville, MI
  • NPI 1073740833

  Multi-Specialty

  Medicare reassignment NPD
• Luke C. Nicholas, MD

  • MOHS-Micrographic Surgery Physician
  • Rockford, MI
  • NPI 1467509620

  Dermatology

  Medicare reassignment NPD
• Alexander Reid, MD

  • MOHS-Micrographic Surgery Physician
  • Danville, PA
  • NPI 1649775461

  Dermatology, MI

  Medicare reassignment NPD

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

{
    "created_epoch": "1508889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1679085161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199519",
            "telephone_number": "616-243-3376",
            "fax_number": "616-243-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1673 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199519",
            "telephone_number": "616-243-3376",
            "fax_number": "616-243-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLVERINE DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-25",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "FREELAND",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-632-0341",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301084275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "23D2141314",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "4301084275",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Gary Wolfe, DPM
• Rebecca Wolfe, MD
• Alyssa Wolffis
• Mark D. Wolfman, DC
• Jordyn Wollman
• Allison Wood, MA
• Jacqueline Wood
• Woodward Detroit CVS LLC (CVS Pharmacy #16437)
• Woodward Detroit CVS, L.L.C. (CVS Pharmacy #08290)
• Tristan J Worthington, DO

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.