Provider Demographics
NPI:1720133580
Name:SKINCARE ASSOCIATES PC
Entity Type:Organization
Organization Name:SKINCARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:ULERY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:734-457-4400
Mailing Address - Street 1:315 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4393
Mailing Address - Country:US
Mailing Address - Phone:734-457-4400
Mailing Address - Fax:734-242-8017
Practice Address - Street 1:315 STEWART RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4393
Practice Address - Country:US
Practice Address - Phone:734-457-4400
Practice Address - Fax:734-242-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJU063597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI070E811880OtherBCBSM NEW
MIOE81006OtherBLUE CROSS BLUE SHIELD
MI070013988OtherRAILROAD MEDICARE
MICL2256OtherRAILROAD GROUP NUMBER
MIOM19200Medicare PIN
MI070E811880OtherBCBSM NEW