Provider Demographics
NPI:1992394944
Name:SKIN PROFESSIONALS WEST, P.C.
Entity Type:Organization
Organization Name:SKIN PROFESSIONALS WEST, P.C.
Other - Org Name:DARABI DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMRUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DARABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-395-6850
Mailing Address - Street 1:582 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4578
Mailing Address - Country:US
Mailing Address - Phone:952-395-6850
Mailing Address - Fax:952-395-6870
Practice Address - Street 1:582 CHERRY DR
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-4578
Practice Address - Country:US
Practice Address - Phone:952-395-6850
Practice Address - Fax:952-395-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty