Healthcare Provider Details

I. General information

NPI: 1124624028
Provider Name (Legal Business Name): RESOLUTE DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 HILLTOP RD STE 102
SHAWNEE KS
66226-3571
US

IV. Provider business mailing address

7111 W 151ST ST
OVERLAND PARK KS
66223-2231
US

V. Phone/Fax

Practice location:
  • Phone: 913-901-5001
  • Fax:
Mailing address:
  • Phone: 913-901-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL L CHRISTIANSEN
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 940-923-9960