Provider Demographics
NPI:1952749376
Name:ADULT & PEDIATRIC DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:ADULT & PEDIATRIC DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-657-7216
Mailing Address - Street 1:350 N MAIN ST STE 250
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1635
Mailing Address - Country:US
Mailing Address - Phone:734-385-7255
Mailing Address - Fax:
Practice Address - Street 1:350 N MAIN ST STE 250
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1635
Practice Address - Country:US
Practice Address - Phone:734-385-7255
Practice Address - Fax:734-274-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336086794207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
974040004Medicare PIN