Provider Demographics
NPI:1053500454
Name:ROCHESTER SKIN CANCER CENTER, P.C.
Entity Type:Organization
Organization Name:ROCHESTER SKIN CANCER CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-293-0800
Mailing Address - Street 1:405 BARCLAY CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4573
Mailing Address - Country:US
Mailing Address - Phone:248-293-0800
Mailing Address - Fax:
Practice Address - Street 1:405 BARCLAY CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4573
Practice Address - Country:US
Practice Address - Phone:248-293-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070F322730OtherBLUE CROSS BLUE SHIELD
MI5607758OtherAETNA
MIDB75711OtherRAILROAD MEDICARE
MI070F322730OtherBLUE CROSS BLUE SHIELD