Dermatology At Midtowne, PC
Dermatology in Grand Rapids, MI. Organization (NPI-2).
NPI number1780933432
StatusActive
Last updated in NPPESMar 18, 2024
Details
- NPI
- 1780933432
- Entity type
- Organization (NPI-2)
- Legal business name
- Dermatology At Midtowne, PC
- Organization subpart
- No
- Enumeration date
- Sep 9, 2012
- Certification date
- Mar 18, 2024
- Last updated
- Mar 18, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
Practice location
555 Midtowne St NeSuite 301
Grand Rapids, MI 49503-5729
Phone 616-248-8864 · Fax 616-248-8874
Mailing address
555 Midtowne St Ne Ste 301Grand Rapids, MI 49503-5729
Phone 616-248-8864 · Fax 616-248-8874
Authorized official
Dipa Suman Patel
Physician/Owner
6162488864
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