DAVID FIVENSON, M.D.DERMATOLOGY, PLLC
NPI 1205037454
Dermatology - Clinical & Laboratory Dermatological Immunology in Ann Arbor, MI

Q: What is David Fivenson, M.D.Dermatology, PLLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Clinical & Laboratory Dermatological Immunology, with taxonomy code 207NI0002X.

Active since May 29, 2007CLIA 23D1007029 · Microscopy

3200 W LIBERTY RD STE C5, ANN ARBOR, MI 48103(734) 222-9630 Get Directions Write a Review

NPPES record last updated: March 25, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About David Fivenson, M.d.dermatology, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DAVID FIVENSON, M.D.DERMATOLOGY, PLLC (NPI 1205037454) is a healthcare organization registered as a clinical & laboratory dermatological immunology in Ann Arbor, Michigan and active in the NPI registry since May 2007. The organization holds a CLIA Microscopy certificate valid through December 5, 2026 and lists David Fivenson, President, as its authorized official.

NPPES Registry Identity

NPI1205037454

Entity TypeOrganization

Primary Taxonomy207NI0002X

Legal Business NameDAVID FIVENSON, M.D.DERMATOLOGY, PLLC

Location Address3200 W LIBERTY RD STE C5Ann Arbor, MI 48103-9746

Mailing Address3200 W Liberty Rd Ste C5Ann Arbor, MI 48103-9746 · (734) 222-9630

Phone(734) 222-9630

Organization SubpartNo

Authorized OfficialDavid FivensonPresident · (734) 222-9630

Enumeration DateMay 29, 2007

Last NPPES UpdateMarch 25, 2026

NPPES CertifiedMarch 25, 2026

✔ NPI 1205037454 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · Clinical & Laboratory Dermatological ImmunologyAllopathic & Osteopathic Physicians

Taxonomy Code207NI0002X

License✔ Licensed in MI · DF404817

Definition

A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases.

3200 W LIBERTY RD STE C5, Ann Arbor, MI 48103

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Other Identifiers 1

OtherDF404817MI · State License

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

David Fivenson, M.d.dermatology, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by March 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateMichiganEnrollment IDO20080103000098Non-DME Part B · Clinic/Group PracticeDue dateMarch 31, 2027

Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to David Fivenson, M.D.Dermatology, PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

David Fivenson, MD

Dermatology

NPI 1235193525

3200 W LIBERTY RD STE C5
Ann Arbor, MI 48103

(734) 222-9630

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 23D1007029

David Fivenson, MD, Dermatology, PLLC · Ann Arbor, MI

Active · expires Dec 5, 2026

CLIA Number23D1007029

Laboratory TypePhysician Office

Certificate Effective DateDecember 6, 2024

Certificate Expiration DateDecember 5, 2026

Laboratory DirectorDavid P. Fivenson

Laboratory Phone(734) 222-9630

Laboratory LocationDavid Fivenson, MD, Dermatology, PLLC3200 W Liberty Road Suite C5, Ann Arbor, MI 48103

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is David Fivenson, M.D.Dermatology, PLLC's NPI number?

The NPI number for David Fivenson, M.D.Dermatology, PLLC is 1205037454. It was assigned to this organization in the NPPES registry on May 29, 2007.

Where is David Fivenson, M.D.Dermatology, PLLC located?

David Fivenson, M.D.Dermatology, PLLC is located at 3200 W Liberty Rd Ste C5, Ann Arbor, MI 48103. The listed phone number is (734) 222-9630.

What is David Fivenson, M.D.Dermatology, PLLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Clinical & Laboratory Dermatological Immunology, with taxonomy code 207NI0002X.

Is David Fivenson, M.D.Dermatology, PLLC enrolled in Medicare?

Yes. David Fivenson, M.D.Dermatology, PLLC is registered in the Medicare PECOS enrollment system.

When is David Fivenson, M.D.Dermatology, PLLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Michigan, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through David Fivenson, M.D.Dermatology, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to David Fivenson, M.D.Dermatology, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does David Fivenson, M.D.Dermatology, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 23D1007029) is associated with this NPI, valid through December 5, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for David Fivenson, M.D.Dermatology, PLLC was last updated on March 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.