Dermatology Specialists of Grand Rapids, PLLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

DERMATOLOGY SPECIALISTS OF GRAND RAPIDS, PLLC

Practice address

1000 East Paris Ave SE Ste 104
Grand Rapids, MI 49546-3680

Phone

(586) 876-2345

NPI assigned

Aug 5, 2025

Organization subpart

No

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

Authorized official

Name

Iltefat Hamzavi

Title

M.D.

Phone

(810) 650-0995

Specialties & licenses 1

Addresses

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

Practitioners 3

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

• Michael James Visconti, DO

  • Dermatology Physician
  • Canton, MI
  • NPI 1235767856
  Medicare reassignment NPD
• Kaylee Diekevers, PA-C

  • Dermatology Physician
  • Grand Rapids, MI
  • NPI 1346938115
  NPD
• Ali A Berry, MD

  • Dermatology Physician
  • Canton, MI
  • NPI 1427009729
  NPD (past)

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

{
    "created_epoch": "1754352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754352000000",
    "number": "1821972548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43151 DALCOMA DR STE 4",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480386306",
            "telephone_number": "586-876-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 EAST PARIS AVE SE STE 104",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463680",
            "telephone_number": "586-876-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY SPECIALISTS OF GRAND RAPIDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-05",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A",
        "authorized_official_last_name": "HAMZAVI",
        "authorized_official_first_name": "ILTEFAT",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "810-650-0995"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Deritter
• Kaitlin Derks, NP
• Layne Derks, PA-C
• Dermatology at Midtowne, PC
• Dermatology Center of Grand Rapids PC
• James Dernocoeur, PA
• Heidi Ruth Deroo, LMSW
• Katie Deroo, D.P.T.
• Steven T Deroos, MD
• Kathleen Anne Derosa Belmont, DC

• MOHS-Micrographic Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• MOHS-Micrographic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; 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.