Provider Demographics
NPI:1750494282
Name:COSMETIC DERMATOLOGY AND VEIN CENTERS OF DOWNRIVER PC
Entity Type:Organization
Organization Name:COSMETIC DERMATOLOGY AND VEIN CENTERS OF DOWNRIVER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO FAOCD
Authorized Official - Phone:248-690-7243
Mailing Address - Street 1:PO BOX 772081
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2022
Mailing Address - Country:US
Mailing Address - Phone:734-282-7266
Mailing Address - Fax:734-282-0353
Practice Address - Street 1:17171 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193
Practice Address - Country:US
Practice Address - Phone:734-282-7266
Practice Address - Fax:734-282-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1750494282Medicaid
MI070H222200OtherBCBS
MI2397AOtherCAPE
MI070008529OtherMEDICARE RAILROAD
0N98100Medicare PIN
MI070H222200OtherBCBS
MIF03729Medicare UPIN