Advanced Dermatology of Michigan PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ADVANCED DERMATOLOGY OF MICHIGAN PC

Practice address

1500 Eureka Rd
Wyandotte, MI 48192-6103

Phone

(734) 282-2500

NPI assigned

Jul 21, 2014

Last updated

Jul 21, 2014By 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

Matt Leavitt, DONPI 1821108341

Title

Owner

Phone

(407) 875-2080

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

Locations

Practitioners 55

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.

• Joshua Bornstein, MD

  • Dermatology Physician
  • Ann Arbor, MI
  • NPI 1437500360
  Medicare reassignment Care Compare group NPD
• Laura Anne Bottomley-Brown, FNP-C

  • Family Nurse Practitioner
  • Petoskey, MI
  • NPI 1568947596
  Medicare reassignment Care Compare group NPD
• Murray Adrian Cotter, M.D.,PH.D.

  • Dermatology Physician
  • Petoskey, MI
  • NPI 1669598744
  Medicare reassignment Care Compare group NPD
• Brian Gelb, MD

  • Emergency Medical Services (Emergency Medicine) Physician
  • Alpena, MI
  • NPI 1194771873
  Medicare reassignment Care Compare group NPD
• Jeremy Aron Grekin, MD

  • Dermatology Physician
  • Warren, MI
  • NPI 1770141509
  Medicare reassignment Care Compare group NPD
• Steven Kenneth Grekin, D.O.

  • Dermatology Physician
  • Warren, MI
  • NPI 1407836877
  Medicare reassignment Care Compare group NPD
• Miguel Angel Herrera-Martinez, MD

  • Dermatology Physician
  • Saint Clair Shores, MI
  • NPI 1669823357
  Medicare reassignment Care Compare group NPD
• Rashawn Michael Jackson, FNP-C

  • Family Nurse Practitioner
  • Wyandotte, MI
  • NPI 1518612373
  Medicare reassignment Care Compare group NPD
• Jennifer A Meitzner, N.P.-C

  • Nurse Practitioner
  • Warren, MI
  • NPI 1154515203
  Medicare reassignment Care Compare group NPD
• Hassan Ben Nasser, M.D.

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Saint Clair Shores, MI
  • NPI 1902293129
  Medicare reassignment Care Compare group NPD
• Paige Norwick

  • Dermatology Physician
  • Southfield, MI
  • NPI 1891355046
  Medicare reassignment Care Compare group NPD
• Trevor K O'Brien, M.D.,

  • Plastic and Reconstructive Surgery Physician
  • Petoskey, MI
  • NPI 1487091989
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405900800000",
    "number": "1851708929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN",
            "address_2": "SUITE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517176",
            "telephone_number": "407-875-2080",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EUREKA RD",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481926103",
            "telephone_number": "734-282-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF MICHIGAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-21",
        "last_updated": "2014-07-21",
        "status": "A",
        "authorized_official_last_name": "LEAVITT",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-875-2080",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne M Abrahamson, MD
• Ahmad Abukhader, DO
• Sarah Adamovich, DPT
• Monica R Adams, PTA
• Sarah Adkins
• Advanced Holistic Health
• Advantage Home Care, Inc.
• Indrit Agalliu, PHARM.D.
• Mona Ahmad, D.D.S
• Bedir Akbar, DO

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; 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.