Provider Demographics
NPI:1245751007
Name:NOVI DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:NOVI DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-946-4787
Mailing Address - Street 1:44000 W 12 MILE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2646
Mailing Address - Country:US
Mailing Address - Phone:248-946-4787
Mailing Address - Fax:248-308-2450
Practice Address - Street 1:44000 W 12 MILE RD STE 103
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-946-4787
Practice Address - Fax:248-716-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty