Provider Demographics
NPI:1629175617
Name:ZEL SKIN & LASER SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ZEL SKIN & LASER SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-746-1018
Mailing Address - Street 1:4100 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1200
Mailing Address - Country:US
Mailing Address - Phone:952-929-8888
Mailing Address - Fax:952-929-9669
Practice Address - Street 1:4100 W 50TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1200
Practice Address - Country:US
Practice Address - Phone:952-929-8888
Practice Address - Fax:952-929-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHFID24276261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24-COOO1054Medicare ID - Type UnspecifiedAMBULATORY SURGERY CENTER