| NPI | 1255851200 |
|---|---|
| Doing Business As | SKIN MD |
| Entity Type | Organization |
| Authorized Contact | SAMUEL J PRUDEN President 859-296-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: KY 34192) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: KY 34192) |
| 207Y00000X Otolaryngology (Licence: KY 34192) | |
| 208200000X Plastic Surgery (Licence: KY 34192) | |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2022-07-21 |