OrganizationActive
Advanced Dermatology of Michigan, PC
NPI 1770973612 · Dermatology Physician · Warren, MI
Provider details
- NPI number
- 1770973612
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Amy Declue, Director, Provider Services(407) 875-2080
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(74/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 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
13450 E 12 Mile Rd
Warren, MI 48088-3671
Phone: (586) 759-5525
Fax: (586) 759-4022
Street-level locationGet directions
Mailing address
151 Southhall Ln
Maitland, FL 32751-7176
Registry dates
- Enumerated
- 2015-01-30
- Last updated
- 2015-01-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.