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WOLVERINE DERMATOLOGY, PC
NPI 1679085161
Dermatology in Wyoming, MI

Active since October 25, 2017CLIA 23D2141314 · Certificate of Compliance
1673 GEZON PKWY SW, WYOMING, MI 49519(616) 243-3376(616) 243-3377 Get Directions Write a Review

NPPES record last updated: February 28, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 28, 2023, Feb 1, 2019, Oct 25, 2017 (3 updates tracked since 2017).

About Wolverine Dermatology, Pc NPPES

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

WOLVERINE DERMATOLOGY, PC (NPI 1679085161) is a healthcare organization registered as a dermatology in Wyoming, Michigan and active in the NPI registry since October 2017. The organization holds a CLIA Certificate of Compliance certificate valid through August 30, 2026 and lists Ryan Dale Freeland, Owner, as its authorized official.

NPPES Registry Identity

NPI1679085161
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameWOLVERINE DERMATOLOGY, PC
Location Address1673 GEZON PKWY SWWyoming, MI 49519-9519
Mailing Address1673 Gezon Pkwy SwWyoming, MI 49519-9519 · (616) 243-3376 · Fax (616) 243-3377
Phone(616) 243-3376
Fax(616) 243-3377
Organization SubpartNo
Authorized OfficialRyan Dale FreelandOwner · (210) 632-0341
Enumeration DateOctober 25, 2017
Last NPPES UpdateFebruary 28, 20233 updates tracked since enumeration
NPPES CertifiedFebruary 28, 2023
✔ NPI 1679085161 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in MI · 4301084275
Definition
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.
1673 GEZON PKWY SW, Wyoming, MI 49519
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Other Identifiers 2

Other23D2141314MI · Clia
Other4301084275MI · State Medical 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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

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 23D2141314

Wolverine Dermatology · Wyoming, MI
Active · expires Aug 30, 2026
CLIA Number23D2141314
Laboratory TypePhysician Office
Certificate Effective DateAugust 31, 2024
Certificate Expiration DateAugust 30, 2026
Laboratory DirectorRyan D. Freeland
Laboratory Phone(616) 243-3376
Laboratory LocationWolverine Dermatology1673 Gezon Parkway SW, Wyoming, MI 49519
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 2

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

DR. JACK A DEKKINGA MD
Dermatology (MOHS-Micrographic Surgery)
1673 GEZON PKWY SW
WYOMING, MI 49519
Kent County (616) 243-3376
DR. RYAN DALE FREELAND MD
Dermatology
1673 GEZON PKWY SW
WYOMING, MI 49519
Kent County (616) 893-6324

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 Wolverine Dermatology, PC's NPI number?

The NPI number for Wolverine Dermatology, PC is 1679085161. It was assigned to this organization in the NPPES registry on October 25, 2017.

Where is Wolverine Dermatology, PC located?

Wolverine Dermatology, PC is located at 1673 Gezon Pkwy SW, Wyoming, MI 49519. The listed phone number is (616) 243-3376.

What is Wolverine Dermatology, PC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Wolverine Dermatology, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 23D2141314) is associated with this NPI, valid through August 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Wolverine Dermatology, PC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Wolverine Dermatology, PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Wolverine Dermatology, PC was last updated on February 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.