Healthcare Provider Details

I. General information

NPI: 1194321075
Provider Name (Legal Business Name): ADVANCED SKIN AND MOHS SURGERY CLINICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2570 NILES RD
SAINT JOSEPH MI
49085-3203
US

IV. Provider business mailing address

2570 NILES RD
SAINT JOSEPH MI
49085-3203
US

V. Phone/Fax

Practice location:
  • Phone: 269-985-0021
  • Fax: 269-281-0281
Mailing address:
  • Phone: 269-985-0021
  • Fax: 269-281-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CLARENCE WILLIAM BROWN JR.
Title or Position: CEO, PRESIDENT
Credential: MD, JD
Phone: 269-985-0021