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General NPI Number Information
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NPI Number | 1053527226
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Entity Type | Organization
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Legal Business Name | MICHIGAN CENTER FOR DERMATOLOGY PLLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 835 MASON ST STE C200
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City | DEARBORN
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State | MI
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Zip | 48124-2231
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Country | US
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Telephone | 313-274-5810
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Fax | 313-274-1499
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Provider Business Mailing Address
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Address Line | 835 MASON ST STE C200
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City | DEARBORN
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State | MI
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Zip | 48124-2231
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Country | US
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Telephone | 313-274-5810
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Fax | 313-274-1499
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. THOMAS P. WALDINGER
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Credential | M.D.
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Telephone | 313-274-5810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 4301043778
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License Number State | MI
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