Organization
NORTHWESTERN MICHIGAN DERMATOLOGY
Active
Organization
NORTHWESTERN MICHIGAN DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOUMIT SHAM PENDHARKAR MHA (OFFICE MANAGER)
(231) 935-8717
Entity
Organization
Contact information
Practice address
550 MUNSON AVE, SUITE 200, TRAVERSE CITY, MI 49686-3580
(231) 935-8717
(231) 935-9230
Mailing address
550 MUNSON AVE, SUITE 200, TRAVERSE CITY, MI 49686-3580
(231) 935-8717
(231) 935-9230
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285743393
NPI
MI
01
—
1437268661
NPI
MI
01
—
1770692873
NPI NUMBER
MI
01
—
1962511097
NPI
MI
05
—
1997138
—
MI
05
—
3347473
—
MI
01
—
4301063462
MI LICENSE
MI
01
—
4301067697
MI LICENSE
MI
01
—
4301077553
MI LICENSE
MI
01
—
4301406284
MICHIGAN LICENSE
MI
05
—
4317989
—
MI
Enumeration date
05/17/2007
Last updated
08/22/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up