Healthcare Provider Details

I. General information

NPI: 1851969927
Provider Name (Legal Business Name): PROSKIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 78TH ST SUITE 318
BLOOMINGTON MN
55420
US

IV. Provider business mailing address

1101 E 78TH ST SUITE 318
BLOOMINGTON MN
55420
US

V. Phone/Fax

Practice location:
  • Phone: 952-426-1421
  • Fax:
Mailing address:
  • Phone: 952-426-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT E SIEGEL
Title or Position: OWNER/SINGLE MEMBER
Credential:
Phone: 952-426-1421