Provider Demographics
NPI:1851588099
Name:DOCTOR'S APPROACH DERMATOLOGY & LASER CENTER, PC
Entity Type:Organization
Organization Name:DOCTOR'S APPROACH DERMATOLOGY & LASER CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:LOUISA
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-364-8170
Mailing Address - Street 1:2900 HANNAH BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5384
Mailing Address - Country:US
Mailing Address - Phone:517-364-8170
Mailing Address - Fax:517-332-1696
Practice Address - Street 1:2900 HANNAH BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5384
Practice Address - Country:US
Practice Address - Phone:517-364-8170
Practice Address - Fax:517-332-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty