| Dermatology Professionals, Pa | |
|
2300 24th St Nw Suite 110 Bemidji MN 56601-6379 | |
| (218) 454-7546 | |
| Not Available |
| Full Name | Dermatology Professionals, Pa |
|---|---|
| Speciality | Clinic/center |
| Location | 2300 24th St Nw, Bemidji, Minnesota |
| Authorized Official Name and Position | Angie Kugel (ADMINISTRATOR) |
| Authorized Official Contact | 2184543065 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dermatology Professionals, Pa 13359 Isle Dr Suite 3 Baxter MN 56425-2222 Ph: (218) 454-7546 | Dermatology Professionals, Pa 2300 24th St Nw Suite 110 Bemidji MN 56601-6379 Ph: (218) 454-7546 |
| NPI Number | 1356714182 |
|---|---|
| Provider Enumeration Date | 11/02/2015 |
| Last Update Date | 11/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356714182 | NPI | - | NPPES |
| 355427000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1699 (Minnesota) | Primary |
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