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NORTHWESTERN MICHIGAN DERMATOLOGY
NPI 1346457488
Dermatology - MOHS-Micrographic Surgery in Traverse City, MI

Active since May 17, 2007CLIA 23D0381425 · Certificate of Compliance
550 MUNSON AVE, SUITE 200, TRAVERSE CITY, MI 49686(231) 935-8717(231) 935-9230 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Northwestern Michigan Dermatology NPPES

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

NORTHWESTERN MICHIGAN DERMATOLOGY (NPI 1346457488) is a healthcare organization registered as a mohs-micrographic surgery in Traverse City, Michigan and active in the NPI registry since May 2007. The organization holds a CLIA Certificate of Compliance certificate valid through December 7, 2027 and lists Soumit Sham Pendharkar, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1346457488
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameNORTHWESTERN MICHIGAN DERMATOLOGY
Location Address550 MUNSON AVE, SUITE 200Traverse City, MI 49686-3580
Mailing Address550 Munson Ave, Suite 200Traverse City, MI 49686-3580 · (231) 935-8717 · Fax (231) 935-9230
Phone(231) 935-8717
Fax(231) 935-9230
Organization SubpartNo
Authorized OfficialSoumit Sham PendharkarOffice Manager · (231) 935-8717
Enumeration DateMay 17, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1346457488 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
550 MUNSON AVE, Traverse City, MI 49686
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Other Identifiers 11

Medicaid3347473MI
Other1962511097MI · Npi
Medicaid1997138MI
Other1285743393MI · Npi
Other1770692873MI · Npi Number
Other1437268661MI · Npi
Other4301063462MI · Mi License
Other4301067697MI · Mi License
Other4301077553MI · Mi License
Other4301406284MI · Michigan License
Medicaid4317989MI

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

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 of Compliance 23D0381425

Northwestern Michigan Dermatology · Traverse City, MI
Active · expires Dec 7, 2027
CLIA Number23D0381425
Laboratory TypePhysician Office
Certificate Effective DateDecember 8, 2025
Certificate Expiration DateDecember 7, 2027
Laboratory DirectorMark R. Pomaranski
Laboratory Phone(231) 935-8717
Laboratory LocationNorthwestern Michigan Dermatology550 Munson Ave, Suite 200, Traverse City, MI 49686
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARTHA A FRANKOWSKI MD
Psychiatry & Neurology (Neurology)
550 MUNSON AVE
TRAVERSE CITY, MI 49686
Grand Traverse County (231) 935-6600
DR. NATALIE ROSE RAMSEY D.P.T.
Specialist
550 MUNSON AVE
TRAVERSE CITY, MI 49686
Grand Traverse County (231) 935-8600
AMELIA CHAPMAN
Audiologist
550 MUNSON AVE
TRAVERSE CITY, MI 49686
Grand Traverse County (231) 935-6455
RONALD L SANDERS PA-C
Physician Assistant
550 MUNSON AVE
TRAVERSE CITY, MI 49686
Grand Traverse County (231) 935-8686
MUSON SERVICES, INC.
Pharmacy (Long Term Care Pharmacy)
550 MUNSON AVE, SUITE G-100
TRAVERSE CITY, MI 49686
Grand Traverse County (231) 935-8730
MUNSON HOME SERVICES
Durable Medical Equipment & Medical Supplies (Oxygen Equipment & Supplies)
550 MUNSON AVE
TRAVERSE CITY, MI 49686
Grand Traverse County (231) 935-6520
MELISSA WALLINGTON OTR/L
Occupational Therapist
550 MUNSON AVE
TRAVERSE CITY, MI 49686
Grand Traverse County (231) 935-8600
SUSAN MEIS PA-C
Physician Assistant
550 MUNSON AVE
TRAVERSE CITY, MI 49686
Grand Traverse County (231) 935-8540

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 Northwestern Michigan Dermatology's NPI number?

The NPI number for Northwestern Michigan Dermatology is 1346457488. It was assigned to this organization in the NPPES registry on May 17, 2007.

Where is Northwestern Michigan Dermatology located?

Northwestern Michigan Dermatology is located at 550 Munson Ave Suite 200, Traverse City, MI 49686. The listed phone number is (231) 935-8717.

What is Northwestern Michigan Dermatology's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Does Northwestern Michigan Dermatology hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 23D0381425) is associated with this NPI, valid through December 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Northwestern Michigan Dermatology was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.