Provider Demographics
NPI:1861861759
Name:UNITED SKIN SPECIALISTS, LTD
Entity Type:Organization
Organization Name:UNITED SKIN SPECIALISTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZELICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-929-8888
Mailing Address - Street 1:4100 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1200
Mailing Address - Country:US
Mailing Address - Phone:952-929-8888
Mailing Address - Fax:952-929-9669
Practice Address - Street 1:4100 W 50TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1200
Practice Address - Country:US
Practice Address - Phone:952-929-8888
Practice Address - Fax:952-929-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty