Provider Demographics
NPI:1659624591
Name:DERMATOLOGY & PHOTOTHERAPY CENTER OF BRIGHTON, PLC
Entity Type:Organization
Organization Name:DERMATOLOGY & PHOTOTHERAPY CENTER OF BRIGHTON, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILTEFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-286-8720
Mailing Address - Street 1:43151 DALCOMA DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6306
Mailing Address - Country:US
Mailing Address - Phone:586-286-8720
Mailing Address - Fax:586-286-8723
Practice Address - Street 1:2305 GENOA BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7004
Practice Address - Country:US
Practice Address - Phone:810-355-4300
Practice Address - Fax:586-286-8723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty