Provider Demographics
NPI:1114427739
Name:CORNERSTONE DERMATOLOGY & SURGERY GROUP, PC
Entity Type:Organization
Organization Name:CORNERSTONE DERMATOLOGY & SURGERY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSTL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-302-6983
Mailing Address - Street 1:1728 NE NINE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-7814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 NW OBRIEN RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1806
Practice Address - Country:US
Practice Address - Phone:816-287-1528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty