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ST JOSEPH DERMATOLOGY AND VEIN CLINIC PLLC NPI 1407309560


NPI Information

NPI: 1407309560
Provider Name: ST JOSEPH DERMATOLOGY AND VEIN CLINIC PLLC
Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 23D2119599

Address:
2500 NILES RD STE 10A
SAINT JOSEPH, MI
ZIP 49085
Phone: (773) 351-2862
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ST JOSEPH DERMATOLOGY AND VEIN CLINIC PLLC is a dermatology in Saint Joseph, MI. The provider is 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. ST JOSEPH DERMATOLOGY AND VEIN CLINIC PLLC NPI is 1407309560. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

2500 NILES RD STE 10A
SAINT JOSEPH, MI
ZIP 49085-272
Phone: (773) 351-2862
Fax: (773) 358-2767

The provider's authorized official is Vassilios Athanasios Dimitropoulos .
The authorized official title is Physician/ Owner/ President and has the following contact phone number (773) 351-2862.

The CLIA number assigned to this NPI record is 23D2119599 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 7/25/2016 and was last updated on 1/26/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207N00000XDermatology4301079801MICHIGANYes
2207ND0101XDermatologyMOHS-Micrographic Surgery4301079801MICHIGANNo
3207NS0135XDermatologyProcedural Dermatology4301079801MICHIGANNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11194838045MEDICAIDMICHIGAN
2I39241MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.