Healthcare Provider Details

I. General information

NPI: 1972211696
Provider Name (Legal Business Name): EQUATION DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W 36TH ST STE 205
MINNEAPOLIS MN
55416-2760
US

IV. Provider business mailing address

2731 CRESCENT RIDGE RD
MINNETONKA MN
55305-2809
US

V. Phone/Fax

Practice location:
  • Phone: 612-268-5005
  • Fax:
Mailing address:
  • Phone: 919-282-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARGARETH PIERRE-LOUIS
Title or Position: OWNER
Credential: MD
Phone: 919-282-6766