Provider Demographics
NPI:1457792616
Name:ELIZABETH PIANTANIDA MD PC
Entity Type:Organization
Organization Name:ELIZABETH PIANTANIDA MD PC
Other - Org Name:SKIN MD DERMATOLOGY AND SKIN ENHANCEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-228-4403
Mailing Address - Street 1:640 SOUTHPOINTE COURT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3855
Mailing Address - Country:US
Mailing Address - Phone:719-228-9488
Mailing Address - Fax:719-424-4858
Practice Address - Street 1:640 SOUTHPOINTE COURT
Practice Address - Street 2:SUITE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3855
Practice Address - Country:US
Practice Address - Phone:719-228-9488
Practice Address - Fax:719-424-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty