| NPI | 1811041890 |
|---|---|
| Other Name | NORTHEAST FAMILY DERMATOLOGY CENTER |
| Entity Type | Organization |
| Authorized Contact | LENISE BANSE Owner 586-263-3130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301047653) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: MI 4301047653) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MI 4301047653) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2010-06-25 |