Advanced Dermatology Pllc

LBN: Advanced Dermatology Pllc
Advanced Dermatology Pllc is an health care organization with primary practice located at 300 E Maiden Ln , Saint Joseph MI 49085-8516. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as the primary health care specialty. Advanced Dermatology Pllc can be contacted via phone (269) 429-7546, or through Kutriata, Mark A via phone (269) 429-7546.

Contact Information

Primary practice address
300 E Maiden Ln Saint Joseph MI 49085-8516
Phone: (269) 429-7546
Fax: (269) 429-0807
Website:
Map and Directions
Authorized official contact:
Name: Kutriata, Mark A Doctor of Osteopathy (DO)
Phone: (269) 429-7546

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 5101012454 Michigan

Profile Details

NPI number 1538192018
LBN Legal business name Advanced Dermatology Pllc
DBA Doing business as
Authorized official Kutriata, Mark A Doctor of Osteopathy (DO)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 8th, 2006
Last updated Mar 25th, 2010 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538192018 NPPES
Other 0751100205 BLUE CROSS
Other CG9582 BLUE CROSS
MEDICAID 350460011 BLUE CROSS
Other 0A10115 BLUE CROSS

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