Provider Demographics
NPI:1750967691
Name:MODERN DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:MODERN DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATANASOVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-375-4033
Mailing Address - Street 1:1000 W UNIVERSITY DR STE 314
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1876
Mailing Address - Country:US
Mailing Address - Phone:248-375-4033
Mailing Address - Fax:248-375-4034
Practice Address - Street 1:1000 W UNIVERSITY DR STE 314
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1876
Practice Address - Country:US
Practice Address - Phone:248-375-4033
Practice Address - Fax:248-375-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty