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General NPI Number Information
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NPI Number | 1063782621
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Entity Type | Organization
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Legal Business Name | TAREEN DERMATOLOGY, P.A.
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 2720 FAIRVIEW AVE N STE 200
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City | ROSEVILLE
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State | MN
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Zip | 55113-1306
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Country | US
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Telephone | 651-633-6883
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Fax | 651-528-6276
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Provider Business Mailing Address
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Address Line | 2720 FAIRVIEW AVE N STE 200
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City | ROSEVILLE
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State | MN
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Zip | 55113-1306
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Country | US
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Telephone | 651-633-6883
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Fax | 651-528-6276
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Authorized Official
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Title or Position | OWNER
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Name | MOHIBA K TAREEN
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Credential | M.D.
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Telephone | 734-546-1760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 54002
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License Number State | MN
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