Provider Demographics
NPI:1609893783
Name:PERFECT SKIN PC
Entity Type:Organization
Organization Name:PERFECT SKIN PC
Other - Org Name:SUSAN ELLIS, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-471-4147
Mailing Address - Street 1:2925 PROFESSIONAL PL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-8126
Mailing Address - Country:US
Mailing Address - Phone:719-471-4147
Mailing Address - Fax:719-471-4148
Practice Address - Street 1:2925 PROFESSIONAL PL
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-8126
Practice Address - Country:US
Practice Address - Phone:719-471-4147
Practice Address - Fax:719-471-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty