Provider Demographics
NPI:1114515608
Name:MI SKIN CENTER, PLLC
Entity Type:Organization
Organization Name:MI SKIN CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCA
Authorized Official - Middle Name:MS
Authorized Official - Last Name:KARTONO WINARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-622-6188
Mailing Address - Street 1:18561 STEEP HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168
Mailing Address - Country:US
Mailing Address - Phone:310-622-6188
Mailing Address - Fax:248-278-4854
Practice Address - Street 1:133 WEST MAIN STREET
Practice Address - Street 2:SUITE 251
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167
Practice Address - Country:US
Practice Address - Phone:248-963-5915
Practice Address - Fax:248-278-4854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-09
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty