MEDICARE: GEORGETOWN DERMATOLOGISTS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070E025000	OTHER		BCBSM GROUP PIN

General Provider Information

NPI Number	:	1982722047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGETOWN DERMATOLOGISTS, P.C.

Provider Business Mailing Address
First Line	:	39242 DEQUINDRE RD
Second Line	:	SUITE 105
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1764
Country	:	US
Telephone Number	:	586-979-1750
Fax Number	:	586-979-4667

Provider Business Practice Location Address
First Line	:	39242 DEQUINDRE RD
Second Line	:	SUITE 105
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1764
Country	:	US
Telephone Number	:	586-979-1750
Fax Number	:	586-979-4667

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL SANFORD FRANK
Credential	:	MD
Telephone Number	:	586-979-1750

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	06/27/2008

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