Provider Demographics
NPI:1497278618
Name:MADKAN DERMATOLOGY, PC
Entity Type:Organization
Organization Name:MADKAN DERMATOLOGY, PC
Other - Org Name:MOSAIC DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-931-0604
Mailing Address - Street 1:150 N ROBERTSON BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2145
Mailing Address - Country:US
Mailing Address - Phone:310-453-3101
Mailing Address - Fax:310-453-3104
Practice Address - Street 1:150 N ROBERTSON BLVD STE 304
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2145
Practice Address - Country:US
Practice Address - Phone:310-453-3101
Practice Address - Fax:310-453-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659691772OtherINDIVIDUAL NPI