Provider Demographics
NPI:1952842098
Name:SKIN CARE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:SKIN CARE SPECIALISTS, PLLC
Other - Org Name:SKIN CANCER SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAKHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-308-3470
Mailing Address - Street 1:17510 W GRAND PKWY S STE 420
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2173
Mailing Address - Country:US
Mailing Address - Phone:832-308-3470
Mailing Address - Fax:832-308-3471
Practice Address - Street 1:17510 W GRAND PKWY S STE 420
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2173
Practice Address - Country:US
Practice Address - Phone:832-308-3470
Practice Address - Fax:832-308-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty