Healthcare Provider Details

I. General information

NPI: 1174863658
Provider Name (Legal Business Name): NORTH METRO DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VILLAGE CENTER DR SUITE 200
NORTH OAKS MN
55127-7848
US

IV. Provider business mailing address

400 VILLAGE CENTER DR SUITE 200
NORTH OAKS MN
55127-7848
US

V. Phone/Fax

Practice location:
  • Phone: 651-789-9800
  • Fax:
Mailing address:
  • Phone: 651-789-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number50109
License Number StateMN

VIII. Authorized Official

Name: DR. ANUDEEP KAUR RAHIL
Title or Position: PHYSCIAN
Credential: M.D.
Phone: 651-789-9800