Healthcare Provider Details

I. General information

NPI: 1467381293
Provider Name (Legal Business Name): TAREEN DERMATOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 HILLCREST DR STE 304
HUDSON WI
54016-9914
US

IV. Provider business mailing address

2720 FAIRVIEW AVE N STE 200
ROSEVILLE MN
55113-1306
US

V. Phone/Fax

Practice location:
  • Phone: 651-633-6883
  • Fax: 651-331-3459
Mailing address:
  • Phone: 651-633-6883
  • Fax: 651-331-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MOHIBA K TAREEN
Title or Position: OWNER & MEDICAL DIRECTOR
Credential: MD
Phone: 651-633-6883