Provider Demographics
NPI:1750568747
Name:DERMINC, PLLC
Entity type:Organization
Organization Name:DERMINC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGENBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-931-2773
Mailing Address - Street 1:1 WILLIAM CARLS DRIVE
Mailing Address - Street 2:REGIONAL SPECIALTY CENTER
Mailing Address - City:COMMERCE
Mailing Address - State:MI
Mailing Address - Zip Code:48382
Mailing Address - Country:US
Mailing Address - Phone:248-937-3419
Mailing Address - Fax:248-937-5148
Practice Address - Street 1:1 WILLIAM CARLS DR
Practice Address - Street 2:REGIONAL SPECIALTY CENTER
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2201
Practice Address - Country:US
Practice Address - Phone:248-937-3419
Practice Address - Fax:248-937-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILH044277207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N94860Medicare PIN