Provider Demographics
NPI:1144582750
Name:ARBOR DERMATOLOGY
Entity Type:Organization
Organization Name:ARBOR DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-623-2104
Mailing Address - Street 1:9480 BRIAR VILLAGE PT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7922
Mailing Address - Country:US
Mailing Address - Phone:719-623-2104
Mailing Address - Fax:
Practice Address - Street 1:9480 BRIAR VILLAGE PT
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7922
Practice Address - Country:US
Practice Address - Phone:719-623-2104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49833207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty