OrganizationActive
Lakeshore Derm & Laser Center PLC
NPI 1538209945 · Procedural Dermatology Physician · Norton Shores, MI
Provider details
- NPI number
- 1538209945
- Entity type
- Organization
- Primary specialty
- Procedural Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jason Van Ittersum, Owner(231) 798-9500
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
6225 Prairie St
Norton Shores, MI 49444-7831
Phone: (231) 798-9500
Fax: (231) 798-9533
Street-level locationGet directions
Mailing address
6225 Prairie St
Norton Shores, MI 49444-7831
Registry dates
- Enumerated
- 2007-02-07
- Last updated
- 2013-10-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.