Healthcare Provider Details

I. General information

NPI: 1316207871
Provider Name (Legal Business Name): INTEGRATIVE SKIN CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 N MONROE ST
MONROE MI
48162-4254
US

IV. Provider business mailing address

2246 N MONROE ST
MONROE MI
48162-4254
US

V. Phone/Fax

Practice location:
  • Phone: 646-287-0734
  • Fax:
Mailing address:
  • Phone: 646-287-0734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NATALIE MONET MOULTON-LEVY
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 734-241-4950