Provider Demographics
NPI:1225619844
Name:COLTON HEALTH MO LLC
Entity Type:Organization
Organization Name:COLTON HEALTH MO LLC
Other - Org Name:ACCURATE SKIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUKHJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-609-4200
Mailing Address - Street 1:9097 E DESERT COVE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:480-553-6263
Mailing Address - Fax:480-609-4233
Practice Address - Street 1:10004 KENNERLY ROAD
Practice Address - Street 2:SUITE 210A
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-5116
Practice Address - Country:US
Practice Address - Phone:314-842-3525
Practice Address - Fax:314-842-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty