Provider Demographics
NPI:1083649628
Name:DERMATOLOGY & SKIN SURGERY CENTER
Entity Type:Organization
Organization Name:DERMATOLOGY & SKIN SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LATOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-660-1670
Mailing Address - Street 1:7070 E DR N
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-8562
Mailing Address - Country:US
Mailing Address - Phone:269-660-1670
Mailing Address - Fax:269-660-0666
Practice Address - Street 1:7070 E DR N
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-8562
Practice Address - Country:US
Practice Address - Phone:269-660-1670
Practice Address - Fax:269-660-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070A310490OtherBCBSM GROUP #
MI070A310490OtherBCBSM GROUP #