Provider Demographics
NPI:1750518031
Name:A COMPREHENSIVE DERMATOLOGY CENTER
Entity type:Organization
Organization Name:A COMPREHENSIVE DERMATOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOIIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-643-7677
Mailing Address - Street 1:1575 W BIG BEAVER RD
Mailing Address - Street 2:STE C12
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3536
Mailing Address - Country:US
Mailing Address - Phone:248-643-7677
Mailing Address - Fax:248-643-7679
Practice Address - Street 1:1575 W BIG BEAVER RD
Practice Address - Street 2:STE C12
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3536
Practice Address - Country:US
Practice Address - Phone:248-643-7677
Practice Address - Fax:248-643-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM059655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4251045-10Medicaid
MIOM57970Medicare PIN
MIG07643Medicare UPIN