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General NPI Number Information
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NPI Number | 1114726767
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Entity Type | Organization
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Legal Business Name | STRAITS AREA DERMATOLOGY CENTER PLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 761 LAFAYETTE AVE
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City | CHEBOYGAN
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State | MI
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Zip | 49721-2117
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Country | US
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Telephone | 231-420-2140
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Fax |
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Provider Business Mailing Address
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Address Line | 761 LAFAYETTE AVE
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City | CHEBOYGAN
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State | MI
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Zip | 49721-2117
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Country | US
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Telephone | 231-420-2140
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | EMILY PTASNIK
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Credential | DO
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Telephone | 989-370-2448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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