Provider Demographics
NPI:1811087075
Name:SOMERSET SKIN CENTRE
Entity type:Organization
Organization Name:SOMERSET SKIN CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURAKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-244-8448
Mailing Address - Street 1:255 KIRTS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5260
Mailing Address - Country:US
Mailing Address - Phone:248-244-8448
Mailing Address - Fax:248-244-8766
Practice Address - Street 1:255 KIRTS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5260
Practice Address - Country:US
Practice Address - Phone:248-244-8448
Practice Address - Fax:248-244-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGM077180207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P08130Medicare ID - Type Unspecified