A Z Dermatology PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4301046052 Issued in MI

Legal business name

A Z DERMATOLOGY PC

Practice address

25225 Greenfield
Southfield, MI 48075

Phone

(248) 788-4380

NPI assigned

May 29, 2008

Last updated

May 29, 2008By 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. Anatoly Zelikov, MD

Title

Owner

Phone

(248) 788-4380

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1942468616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31051 WESTWOOD ROAD",
            "address_2": "IN CARE OF A ZELIKOV MD",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "48331",
            "telephone_number": "248-788-4380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25225 GREENFIELD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "248-788-4380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A Z DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "ZELIKOV",
        "authorized_official_first_name": "ANATOLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-788-4380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301046052",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "MI",
            "license": "4301046052",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103267265",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; 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.