ADVANCED DERMATOLOGY PLLC (NPI# 1538192018) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538192018 |
| Entity Type | Organization |
| Organization Name | ADVANCED DERMATOLOGY PLLC |
| Practice Address |
300 E Maiden Ln Saint Joseph MI 49085-8516 |
| Practice Telephone | 2694297546 |
| Practice Fax Number | 2694290807 |
| Mailing Telephone | 2694297546 |
| Mailing Fax Number | 2694290807 |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2010-03-25 |
| Authorized Official Name | MARK A KUTRIATA (OWNER/PROVIDER) |
| Authorized Official Telephone | 2694297546 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 5101012454 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | PALMETTO GBA GROUP | CG9582 | 01 |
| BLUE CROSS | 0751100205 | 01 | |
| MI | BCBSM GROUP | 0A10115 | 01 |
| MI | 350460011 | 05 |
| Street Address |
300 E MAIDEN LN |
| City | SAINT JOSEPH |
| State | MI |
| Zip Code | 49085-8516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053829937 | Hilary Beyerlein | Physician Assistant | 300 E Maiden Ln, Saint Joseph, MI 49085-8516 | 2018-01-13 |
| 1962780841 | James J Yousif | Dermatology | 300 E Maiden Ln, Saint Joseph, MI 49085-8516 | 2011-07-27 |
| 1952400012 | Erine Allison Kupetsky | Dermatology | 300 E Maiden Ln, Saint Joseph, MI 49085-8516 | 2006-09-22 |
| 1114038700 | Johanna Elaine Killian | Physician Assistant | 300 E Maiden Ln, Saint Joseph, MI 49085-8516 | 2006-08-31 |
| 1033220637 | Mark A Kuriata | Dermatology | 300 E Maiden Ln, Saint Joseph, MI 49085-8516 | 2006-08-31 |
| 1134145253 | Susan E Kingbarry | Physician Assistant | 300 E Maiden Ln, Saint Joseph, MI 49085-8516 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134758949 | Ahmed Elshareif | Student in an Organized Health Care Education/Training Program | Lakeland Health, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2020-04-03 |
| 1033747225 | Ezra Fox | Student in an Organized Health Care Education/Training Program | Lakeland Health- Gme, 1234 Napier Avenue, St. Joseph, MI 49085 | 2020-04-01 |
| 1679033930 | Asad Butt | Student in an Organized Health Care Education/Training Program | Lakeland Health-gme, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2019-03-22 |
| 1184194714 | Benjamin Phillip Knuth | Physical Therapist | 3950 Hollywood Road, Suite 140, Saint Joseph, MI 49085 | 2018-11-27 |
| 1336624279 | Brandi Chatot | Counselor | 1101 Broad Street #8, Saint Joseph, MI 49085 | 2018-09-26 |
| 1396239562 | Lakeland Medical Practices | Family Medicine | 2500 Niles Ave., Suite 1, St. Joseph, MI 49085 | 2018-06-20 |
| 1760976518 | Premier Health Associates, Inc. | Home Health | 1111 Main Sr, St Joseph, MI 49085 | 2018-06-15 |
| 1053817783 | Chantell Strong | Student in an Organized Health Care Education/Training Program | Lakeland Health - Gme, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2018-04-02 |
| 1386144053 | Anjana Gupta, Dds, Pllc | Dentist | 2800 Niles Road, Saint Joseph, MI 49085 | 2018-02-19 |
| 1356858997 | Hope Reborn Counseling, Pllc | Counselor | 2816 Willa Dr, Saint Joseph, MI 49085 | 2018-01-04 |
| Find all providers in zip 49085 | ||||
| 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 |
|---|---|---|---|---|
| 1386654390 | Clarence W. Brown Jr. | Dermatology | 2570 Niles Rd, Saint Joseph, MI 49085-3203 | 2006-08-09 |
| 1952385437 | Richard Joseph Walsh | Dermatology | 3917 Sherman Avenue, Saint Joseph, MO 64506-3649 | 2005-11-30 |
| 1922557347 | Lakeland Medical Practices | Dermatology | 3901 Stonegate Park, Suite 300, Saint Joseph, MI 49085-9137 | 2016-09-27 |
| 1306230784 | Cody Hanson | Dermatology | 5204 N Belt Hwy, Saint Joseph, MO 64506-1211 | 2015-03-24 |
| 1962780841 | James J Yousif | Dermatology | 300 E Maiden Ln, Saint Joseph, MI 49085-8516 | 2011-07-27 |
| 1992935472 | St. Josephs Dermatology | Dermatology | 2500 Niles Rd, Suite 11, Saint Joseph, MI 49085-3237 | 2009-07-20 |
| 1932338746 | Ana Marie Liolios | Dermatology | 5204 N Belt Hwy, Plastic Surgery and Dermatology, Saint Joseph, MO 64506-1211 | 2009-07-14 |
| 1568504397 | Riddhi Jay Shah | Dermatology | 3901 Stonegate Park, Suite 300, Saint Joseph, MI 49085-9137 | 2007-02-12 |
| 1740358159 | Melody L.stone, M.d., P.a. | Dermatology | 1419 Village Dr, Saint Joseph, MO 64506-2459 | 2006-12-01 |
| 1952400012 | Erine Allison Kupetsky | Dermatology | 300 E Maiden Ln, Saint Joseph, MI 49085-8516 | 2006-09-22 |
| Find all providers in SAINT JOSEPH | ||||
| City | SAINT JOSEPH |
| Zip Code | 49085 |
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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.