Provider Demographics
NPI:1629043534
Name:DERMATOLOGY AND CUTANEOUS SURGERY, INC
Entity Type:Organization
Organization Name:DERMATOLOGY AND CUTANEOUS SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-3376
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:498A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-3376
Mailing Address - Fax:314-251-5781
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:498A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-3376
Practice Address - Fax:314-251-5781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBM0655588174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0002011318Medicare ID - Type Unspecified
A14101Medicare UPIN