Provider Demographics
NPI:1780863498
Name:MADELINE TURNER DO PC
Entity Type:Organization
Organization Name:MADELINE TURNER DO PC
Other - Org Name:DERMATOLOGY CENTER OF LAKE ORION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-814-7546
Mailing Address - Street 1:1261 S LAPEER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1419
Mailing Address - Country:US
Mailing Address - Phone:248-814-7546
Mailing Address - Fax:248-814-8900
Practice Address - Street 1:1261 S LAPEER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1419
Practice Address - Country:US
Practice Address - Phone:248-814-7546
Practice Address - Fax:248-814-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011132207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3182186Medicaid
MI0756300995OtherBCBS
MI0756300995OtherBCBS
MIG14204Medicare UPIN