Provider Demographics
NPI:1811069222
Name:DERMATOLOGY ASSOCIATES OF NORTHERN MICHIGAN, P.C.
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF NORTHERN MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-2230
Mailing Address - Street 1:4170 CEDAR BLUFF DRIVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-487-2230
Mailing Address - Fax:231-487-6172
Practice Address - Street 1:4170 CEDAR BLUFF DRIVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-487-2230
Practice Address - Fax:231-487-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070B410100OtherBCBS GROUP
MIOM75570OtherMEDICARE GROUP