Provider Demographics
NPI:1003460874
Name:DERM INSTITUTE OF WEST MICHIGAN PLC
Entity Type:Organization
Organization Name:DERM INSTITUTE OF WEST MICHIGAN PLC
Other - Org Name:DERM INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-606-7403
Mailing Address - Street 1:7234 TORY DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9066
Mailing Address - Country:US
Mailing Address - Phone:616-485-2012
Mailing Address - Fax:
Practice Address - Street 1:1661 CRYSTAL SPRINGS BLVD SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-4931
Practice Address - Country:US
Practice Address - Phone:616-326-0114
Practice Address - Fax:616-369-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty