=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184597825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKIN CARE PHYSICIANS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2025
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37595 7 MILE RD STE 240
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48152-1489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-307-2400
-----------------------------------------------------
Fax | 248-852-1919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6632 TELEGRAPH RD # 348
-----------------------------------------------------
City | BLOOMFIELD HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48301-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-852-1900
-----------------------------------------------------
Fax | 248-852-1919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | FANAR JEMMOA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-852-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------