KALAMAZOO DERMATOLOGY, P.C. (NPI# 1073607925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073607925 |
| Entity Type | Organization |
| Organization Name | KALAMAZOO DERMATOLOGY, P.C. |
| Other Organization Name | KALAMAZOO DERMATOLOGY & SKIN CANCER CENTER |
| Practice Address |
6100 Newport Rd Ste 100 Portage MI 49002-9235 |
| Practice Telephone | 2693434679 |
| Practice Fax Number | 2693435929 |
| Mailing Telephone | 2693434679 |
| Mailing Fax Number | 2693435929 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2015-01-29 |
| Authorized Official Name | LORI KOLLIN (PRACTICE MANAGER) |
| Authorized Official Telephone | 2693434679 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | PTAN | CA7827 | 01 |
| Other Name | Type Code |
|---|---|
| KALAMAZOO DERMATOLOGY & SKIN CANCER CENTER | Doing Business As Name - Organization |
| Street Address |
6100 NEWPORT RD STE 100 |
| City | PORTAGE |
| State | MI |
| Zip Code | 49002-9235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750472387 | John Thomas Gallagher | Clinical Neuropsychologist | 6100 Newport Rd, Suite 222, Portage, MI 49002-9235 | 2006-09-27 |
| 1144835133 | Rachel Mills | Counselor | 6100 Newport Rd, Portage, MI 49002-9235 | 2020-09-15 |
| 1326436395 | Samita Shah | Physician Assistant | 6100 Newport Rd, Portage, MI 49002-9235 | 2014-12-29 |
| 1396143079 | Terrill Psychological Services Pllc | Psychologist | 6100 Newport Rd, Suite 204, Portage, MI 49002-9235 | 2014-12-12 |
| 1710393798 | Jackson Grayson & Campbell | In Home Supportive Care | 6100 Newport Rd, Suite 208, Portage, MI 49002-9235 | 2014-07-10 |
| 1407267529 | Jeff Emmer | In Home Supportive Care | 6100 Newport Rd, Suite 208, Portage, MI 49002-9235 | 2014-05-12 |
| 1922268861 | John T. Gallagher and Associates, P.l.c. | Psychologist | 6100 Newport Rd, Suite 222, Portage, MI 49002-9235 | 2008-06-13 |
| 1225252356 | David Frank Fatzinger | Psychologist | 6100 Newport Rd, Suite 222, Portage, MI 49002-9235 | 2007-04-12 |
| 1265593685 | Jessica L Umlor | Physician Assistant | 6100 Newport Rd, Suite 100, Portage, MI 49002-9235 | 2006-12-12 |
| 1750475695 | Paul W Wang | Dermatology | 6100 Newport Rd, Suite 100, Portage, MI 49002-9235 | 2006-10-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932604204 | Susan Vandewalker | Physical Therapist | 8001 Angling Rd., Portage, MI 49002 | 2018-03-28 |
| 1134634934 | Portage Chiropractic and Wellness Center | Chiropractor | 609 E. Centre, Portage, MI 49002 | 2017-12-04 |
| 1548620537 | Patricia Eid | Behavioral Analyst | 1016 E Milham Ave, Suite 2, Portage, MI 49002 | 2016-03-03 |
| 1386045383 | Pinnacle Senior Care of Kalamazoo, LLC | Home Health | 2725 Airview Blvd Ste 105b, Portage, MI 49002 | 2014-09-09 |
| 1104241611 | Meredith Ayers Holland | Behavioral Analyst | 9616 Portage Road, Portage, MI 49002 | 2014-02-20 |
| 1619211919 | Daketia L Thomas | Massage Therapist | 8314 Portage Rd, Suite D, Kalamazoo, MI 49002 | 2012-11-27 |
| 1831457142 | Kinetic Kids, LLC | Occupational Therapist | 540 East Milham, Portage, MI 49002 | 2012-04-25 |
| 1154689404 | Lauren Michelle Mattaliano | Occupational Therapist | 540 E. Milham Road, Portage, MI 49002 | 2012-04-24 |
| 1114219227 | South Michigan Psychiatric Services LLC | Psychiatry & Neurology | 5390 Lovers Ln, Third Floor, Portage, MI 49002 | 2011-05-07 |
| 1174836316 | Premier Neuropsychiatry Plc | Psychiatry & Neurology | 5930 Lovers Lane, Portage, MI 49002 | 2010-07-16 |
| Find all providers in zip 49002 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518925528 | Craig Albert Mohney | Dermatology | 3000 Old Centre Rd, Portage, MI 49024-4883 | 2006-05-02 |
| 1710975255 | Ruchik S Desai | Dermatology | 3190 Lancer St, Portage, IN 46368-4408 | 2005-10-10 |
| 1225411705 | Ryan Timothy Jones | Dermatology | 3000 Old Centre Rd, Portage, MI 49024-4883 | 2015-07-02 |
| 1659637791 | Emily Margaret Garritson | Dermatology | 3190 Lancer St, Portage, IN 46368-4488 | 2012-04-03 |
| 1619179710 | Jessica Elaine Liggett | Dermatology | 3000 Old Centre Rd, Portage, MI 49024-4883 | 2007-06-01 |
| 1750475695 | Paul W Wang | Dermatology | 6100 Newport Rd, Suite 100, Portage, MI 49002-9235 | 2006-10-03 |
| 1891889713 | Gerald D Karabin | Dermatology | 6100 Newport Rd, Ste 100, Portage, MI 49002-9235 | 2006-10-03 |
| 1841384773 | William F Weston | Dermatology | 6100 Newport Rd, Suite 100, Portage, MI 49002-9235 | 2006-10-03 |
| 1063470078 | David Charles Semler | Dermatology | 3000 Old Centre Rd, Portage, MI 49024-4883 | 2006-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710595616 | Diamond Dermatology, Pllc. | Dermatology | 3206 N Main St, Royal Oak, MI 48073-3424 | 2020-07-16 |
| 1477179174 | Alicia Scopis | Dermatology | 50505 Schoenherr Rd Ste 325, Shelby Township, MI 48315-3142 | 2020-06-18 |
| 1003460874 | Derm Institute of West Michigan Plc | Dermatology | 6750 Kalamazoo Ave, Suites C & D, Grand Rapids, MI 49508 | 2019-07-30 |
| 1770080939 | Emily Rose Davis | Dermatology | 5333 Mcauley Dr Rm 2111, Ypsilanti, MI 48197-1097 | 2018-04-12 |
| 1245744242 | Maureen Cliffel Do Pllc | Dermatology | 26454 Woodward Ave Ste 200, Royal Oak, MI 48067-0969 | 2017-11-29 |
| 1306375365 | Lindsay Christina El Awadi | Dermatology | 50182 Schoenherr Rd, Shelby Twp, MI 48315-3136 | 2017-06-05 |
| 1396278099 | Sasank Konda | Dermatology | 3031 W. Grand Blvd., 8th Floor, Dept. of Dermatology, Detroit, MI 48202 | 2017-04-10 |
| 1790132439 | Saara Kanervikkoaho-crane | Dermatology | 1517 Granger Ave, Ann Arbor, MI 48104-4426 | 2016-05-23 |
| 1588019053 | Legacy Dermatology Group PC | Dermatology | 1392 S Cass Lake Rd, Waterford, MI 48328 | 2016-05-03 |
| 1679955041 | Luke D Killpack | Dermatology | 5333 Mcauley Dr Rm 5003, Ypsilanti, MI 48197-1020 | 2015-06-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.