Healthcare Provider Details

I. General information

NPI: 1447196076
Provider Name (Legal Business Name): DERMATOLOGY & COSMETIC CENTER OF OWOSSO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S WASHINGTON ST STE 16
OWOSSO MI
48867-2901
US

IV. Provider business mailing address

201 S WASHINGTON ST STE 16
OWOSSO MI
48867-2901
US

V. Phone/Fax

Practice location:
  • Phone: 833-322-3376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: WASIM NASIR
Title or Position: PHYSICIAN
Credential: MD
Phone: 833-322-3376