Provider Demographics
NPI:1629610415
Name:ALOUPIS DERMATOLOGY, PA
Entity Type:Organization
Organization Name:ALOUPIS DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-313-1230
Mailing Address - Street 1:2141 S ALTERNATE A1A STE 430
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4063
Mailing Address - Country:US
Mailing Address - Phone:561-313-1230
Mailing Address - Fax:561-249-3192
Practice Address - Street 1:2141 S ALTERNATE A1A STE 430
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4063
Practice Address - Country:US
Practice Address - Phone:561-313-1230
Practice Address - Fax:561-249-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-13
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty