Provider Demographics
NPI:1285220079
Name:CENTRAL MINNESOTA DERMATOLOGY, PA
Entity Type:Organization
Organization Name:CENTRAL MINNESOTA DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-831-8388
Mailing Address - Street 1:1903 S 6TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4599
Mailing Address - Country:US
Mailing Address - Phone:218-454-3376
Mailing Address - Fax:
Practice Address - Street 1:415 BARCLAY AVE
Practice Address - Street 2:
Practice Address - City:PINE RIVER
Practice Address - State:MN
Practice Address - Zip Code:56474-1603
Practice Address - Country:US
Practice Address - Phone:218-454-3376
Practice Address - Fax:218-454-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center