Provider Demographics
NPI:1861509234
Name:SKIN CANCER TREATMENT CENTER
Entity Type:Organization
Organization Name:SKIN CANCER TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-436-5625
Mailing Address - Street 1:10001 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6136
Mailing Address - Country:US
Mailing Address - Phone:954-436-5625
Mailing Address - Fax:954-678-3989
Practice Address - Street 1:10001 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6136
Practice Address - Country:US
Practice Address - Phone:954-436-5625
Practice Address - Fax:954-678-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036826174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0970Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER