Basic Information
| Provider Information | |||||||||
| NPI: | 1689306680 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DERMATOLOGY SPECIALISTS OF ANN ARBOR, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43151 DALCOMA DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480386306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5868762345 | ||||||||
| FaxNumber: | 8667906803 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 WHITEHALL DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481059694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346773376 | ||||||||
| FaxNumber: | 7345723229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2022 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | VANHALL | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. PROJECT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5868762345 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.