Provider Demographics
NPI:1346732880
Name:THE SKIN CANCER AND DERMATOLOGY CENTER PLC
Entity Type:Organization
Organization Name:THE SKIN CANCER AND DERMATOLOGY CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-632-8456
Mailing Address - Street 1:5199 N ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9201
Mailing Address - Country:US
Mailing Address - Phone:231-632-8456
Mailing Address - Fax:231-525-2062
Practice Address - Street 1:5199 N ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9201
Practice Address - Country:US
Practice Address - Phone:231-486-0230
Practice Address - Fax:231-525-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104387207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty