Healthcare Provider Details

I. General information

NPI: 1548426885
Provider Name (Legal Business Name): NORTH SOUND DERMATOLOGY P.C., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15906 MILL CREEK BLVD SUITE 105
MILL CREEK WA
98012-1234
US

IV. Provider business mailing address

15906 MILL CREEK BLVD SUITE 105
MILL CREEK WA
98012-1234
US

V. Phone/Fax

Practice location:
  • Phone: 425-385-2009
  • Fax: 425-939-0807
Mailing address:
  • Phone: 425-385-2009
  • Fax: 425-939-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD00044310
License Number StateWA

VIII. Authorized Official

Name: DR. DIETER KURT THOMAS SCHMIDT
Title or Position: PRESIDENT, CEO
Credential: M.D.
Phone: 425-385-2009