Provider Demographics
NPI:1477128189
Name:DERMATOLOGY MEDICAL CENTER OF MI, PC
Entity Type:Organization
Organization Name:DERMATOLOGY MEDICAL CENTER OF MI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDIL
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:ALDARONDO-ANTONINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-286-3604
Mailing Address - Street 1:2545 W SILVER LAKE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2662
Mailing Address - Country:US
Mailing Address - Phone:810-215-0999
Mailing Address - Fax:810-629-2377
Practice Address - Street 1:2545 W SILVER LAKE RD STE 2
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2662
Practice Address - Country:US
Practice Address - Phone:810-215-0999
Practice Address - Fax:810-629-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty