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General NPI Number Information
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NPI Number | 1366255861
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Entity Type | Organization
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Legal Business Name | ALLUMA DERMATOLOGY PLLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 922 HIGHWAY 55
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City | MEDINA
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State | MN
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Zip | 55340-9543
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Country | US
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Telephone | 612-849-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 922 HIGHWAY 55
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City | MEDINA
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State | MN
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Zip | 55340-9543
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Country | US
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Telephone | 763-445-9040
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Fax | 310-767-6732
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Authorized Official
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Title or Position | CEO
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Name | RONDA FARAH
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Credential | MD
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Telephone | 763-445-9040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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