Provider Demographics
NPI:1902847098
Name:PARAGON HEALTH, P.C.
Entity Type:Organization
Organization Name:PARAGON HEALTH, P.C.
Other - Org Name:SOUTHWEST MICHIGAN DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-341-4554
Mailing Address - Street 1:3000 OLD CENTRE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4883
Mailing Address - Country:US
Mailing Address - Phone:269-321-7546
Mailing Address - Fax:269-321-1705
Practice Address - Street 1:3000 OLD CENTRE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4883
Practice Address - Country:US
Practice Address - Phone:269-321-7546
Practice Address - Fax:269-321-1705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARAGON HEALTH, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070C910440OtherBLUE CROSS & BLUE SHIELD
CN8688OtherRAILROAD MEDICARE
CN8688OtherRAILROAD MEDICARE