Provider Demographics
NPI:1093408882
Name:APEX SKIN CENTER PLLC
Entity Type:Organization
Organization Name:APEX SKIN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KNACKSTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-762-6845
Mailing Address - Street 1:1006 PROCURE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2627
Mailing Address - Country:US
Mailing Address - Phone:919-762-6845
Mailing Address - Fax:919-762-6865
Practice Address - Street 1:1006 PROCURE ST STE 100
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2627
Practice Address - Country:US
Practice Address - Phone:919-762-6845
Practice Address - Fax:919-762-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty