Greater Michigan Dermatology, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

GREATER MICHIGAN DERMATOLOGY, PLLC

Practice address

849 Health Park Blvd
Grand Blanc, MI 48439-7383

Phone

(810) 498-4354

Fax

(810) 498-4355

NPI assigned

Oct 23, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Kelsey Lawrence, MDNPI 1225410756

Title

Owner

Phone

(810) 498-4354

Specialties & licenses 1

Addresses

Other identifiers 1

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 1

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

• Kelsey Louise Lawrence, M.D.

  • Dermatology Physician
  • Grand Blanc, MI
  • NPI 1225410756

  Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1571788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1700429685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "849 HEALTH PARK BLVD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484397383",
            "telephone_number": "415-802-1310",
            "fax_number": "810-498-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "849 HEALTH PARK BLVD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484397383",
            "telephone_number": "810-498-4354",
            "fax_number": "810-498-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER MICHIGAN DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-23",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "KELSEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-498-4354",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1225410756",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Alfonso Grasso, DNP, APRN, PMHNP-BC
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• Dianne E Gregory, M.D.

• Dermatology Physician in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.