NPIMap

Organization Active NPI

Northern Michigan Dermatology PC

  • Dermatology Physician
  • Cheboygan, MI
National Provider Identifier
1801082987
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
WG008271 Issued in MI
Legal business name
NORTHERN MICHIGAN DERMATOLOGY PC
Practice address
125 N Main St
Cheboygan, MI 49721-1637
Phone
(231) 627-3800
Fax
(231) 627-2482
NPI assigned
Sep 21, 2007
Last updated
Oct 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Authorized official

Name
William Roger Gray, D.O.NPI 1831200369
Title
Physician/Corporate President
Phone
(231) 627-3800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X WG008271 MI Primary

Addresses

Primary practice location

125 N Main St
Cheboygan, MI 49721-1637

Mailing address

125 N Main St
Cheboygan, MI 49721-1637
Phone (231) 627-3800

Other identifiers 2

IdentifierTypeStateIssuer
3055165MedicaidMI
0751600054OtherBCBSM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1801082987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N MAIN ST",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497211637",
            "telephone_number": "231-627-3800",
            "fax_number": "231-627-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N MAIN ST",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497211637",
            "telephone_number": "231-627-3800",
            "fax_number": "231-627-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MICHIGAN DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ROGER",
        "authorized_official_title_or_position": "PHYSICIAN/CORPORATE PRESIDENT",
        "authorized_official_telephone_number": "231-627-3800",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "WG008271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3055165",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0751600054",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheboygan, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.