Provider Demographics
NPI:1710922661
Name:BAY VIEW DERMATOLOGY
Entity Type:Organization
Organization Name:BAY VIEW DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:S
Authorized Official - Last Name:VAZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-6700
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-6700
Mailing Address - Fax:231-487-0303
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 510
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-6700
Practice Address - Fax:231-487-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070015180OtherRR MEDICARE
MI0P32670Medicare PIN