Provider Demographics
NPI:1174863658
Name:NORTH METRO DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:NORTH METRO DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUDEEP
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:RAHIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-789-9800
Mailing Address - Street 1:400 VILLAGE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7848
Mailing Address - Country:US
Mailing Address - Phone:651-789-9800
Mailing Address - Fax:
Practice Address - Street 1:400 VILLAGE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7848
Practice Address - Country:US
Practice Address - Phone:651-789-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty