NORTHWESTERN MICHIGAN DERMATOLOGY
NPI 1346457488
Dermatology - MOHS-Micrographic Surgery in Traverse City, MI
- Organization
- Dermatology
- MOHS-Micrographic Surgery
- CLIA Number: 23D0381425
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-07-2027
About NORTHWESTERN MICHIGAN DERMATOLOGY
This page provides the complete NPI Profile along with additional information for Northwestern Michigan Dermatology, a provider established in Traverse City, Michigan operating as a Dermatology, focusing in mohs-micrographic surgery . The healthcare provider is registered in the NPI registry with number 1346457488 assigned on May 2007. The practitioner's primary taxonomy code is 207ND0101X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Soumit Sham Pendharkar Mha (Office Manager)
- NPI
- 1346457488 Verify this NPI
- Provider Name
- NORTHWESTERN MICHIGAN DERMATOLOGY
- Entity Type
- Organization
- Location Address
- 550 MUNSON AVE SUITE 200 TRAVERSE CITY, MI 49686
- Location Phone
- (231) 935-8717
- Location Fax
- (231) 935-9230
- Mailing Address
- 550 MUNSON AVE SUITE 200 TRAVERSE CITY, MI 49686
- Mailing Phone
- (231) 935-8717
- Mailing Fax
- (231) 935-9230
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-17-2007
- Last Update Date
- 08-22-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dermatology MOHS-Micrographic Surgery
- Taxonomy Code
- 207ND0101X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- 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.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 3347473 | MEDICAID (05) | MI | |
| 1962511097 | OTHER (01) | MI | NPI |
| 1997138 | MEDICAID (05) | MI | |
| 1285743393 | OTHER (01) | MI | NPI |
| 1770692873 | OTHER (01) | MI | NPI NUMBER |
| 1437268661 | OTHER (01) | MI | NPI |
| 4301063462 | OTHER (01) | MI | MI LICENSE |
| 4301067697 | OTHER (01) | MI | MI LICENSE |
| 4301077553 | OTHER (01) | MI | MI LICENSE |
| 4301406284 | OTHER (01) | MI | MICHIGAN LICENSE |
| 4317989 | MEDICAID (05) | MI |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 23D0381425
- Facility Type
- Physician Office
- Certificate Effective Date
- December 08, 2025
- Certificate Expiration Date
- December 07, 2027
- Laboratory Director
- MARK R. POMARANSKI
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Northwestern Michigan Dermatology after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
TRAVERSE CITY, MI 49686
TRAVERSE CITY, MI 49686
TRAVERSE CITY, MI 49686
TRAVERSE CITY, MI 49686
TRAVERSE CITY, MI 49686
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1346457488, enumerated as an "organization" on May 17, 2007.
The provider is located at 550 MUNSON AVE SUITE 200 TRAVERSE CITY, MI 49686 and the phone number is (231) 935-8717.
Dermatology with taxonomy code 207ND0101X and a focus in MOHS-Micrographic Surgery.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
