ADVANCED DERMATOLOGY OF MICHIGAN, PC
NPI 1770973612
Dermatology in Warren, MI

Q: What is Advanced Dermatology Of Michigan, PC's NPI number?

The NPI number for Advanced Dermatology Of Michigan, PC is 1770973612. It was assigned to this organization in the NPPES registry on January 30, 2015.

Q: What is Advanced Dermatology Of Michigan, PC's specialty?

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

Active since January 30, 2015CLIA Certified · 2 labs

13450 E 12 MILE RD, WARREN, MI 48088(586) 759-5525(586) 759-4022 Get Directions Write a Review

NPPES record last updated: January 30, 2015. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Advanced Dermatology Of Michigan, Pc NPPES

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

ADVANCED DERMATOLOGY OF MICHIGAN, PC (NPI 1770973612) is a healthcare organization registered as a dermatology in Warren, Michigan and active in the NPI registry since January 2015. The organization holds 2 active CLIA laboratory certificates and lists Amy Declue, Director, Provider Services, as its authorized official.

NPPES Registry Identity

NPI1770973612

Entity TypeOrganization

Primary Taxonomy207N00000X

Legal Business NameADVANCED DERMATOLOGY OF MICHIGAN, PC

Location Address13450 E 12 MILE RDWarren, MI 48088-3671

Mailing Address151 Southhall Ln, Ste 300Maitland, FL 32751-7176 · (407) 875-2080 · Fax (407) 650-3455

Phone(586) 759-5525

Fax(586) 759-4022

Organization SubpartNo

Authorized OfficialAmy DeclueDirector, Provider Services · (407) 875-2080

Enumeration DateJanuary 30, 2015

✔ NPI 1770973612 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

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.

13450 E 12 MILE RD, Warren, MI 48088

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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 2

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 Accreditation 23D2045052

Advanced Dermatology Of Michigan · Warren, MI

Active · expires Apr 21, 2028

CLIA Number23D2045052

Laboratory TypePhysician Office

Certificate Effective DateApril 22, 2026

Certificate Expiration DateApril 21, 2028

Laboratory DirectorMichael W. Whitworth

Laboratory Phone(407) 284-3407

Laboratory LocationAdvanced Dermatology Of Michigan13450 E 12 Mile Road, Warren, MI 48088

CLIA data matches this NPI record on: Address Name

This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 23D1096885

Advanced Dermatology Of Michigan · Warren, MI

Active · expires Mar 12, 2027

CLIA Number23D1096885

Laboratory TypePhysician Office

Certificate Effective DateMarch 13, 2025

Certificate Expiration DateMarch 12, 2027

Laboratory DirectorSteven K. Grekin

Laboratory Phone(407) 284-3407

Laboratory LocationAdvanced Dermatology Of Michigan13450 E 12 Mile Road, Warren, MI 48088

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 12

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

DON U COLLIER DO

Dermatology