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General NPI Number Information
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NPI Number | 1417238999
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Entity Type | Organization
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Legal Business Name | INNOVATIVE DERMATOLOGY P A
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 5425 W SPRING CREEK PKWY SUITE 265
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City | PLANO
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State | TX
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Zip | 75024-4236
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Country | US
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Telephone | 214-919-3500
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Fax | 214-919-3501
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Provider Business Mailing Address
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Address Line | 5425 W SPRING CREEK PKWY SUITE 265
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City | PLANO
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State | TX
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Zip | 75024-4236
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Country | US
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Telephone | 214-919-3500
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Fax | 214-919-3501
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Authorized Official
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Title or Position | OWNER
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Name | SEEMAL R DESAI
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Credential | MD
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Telephone | 214-919-3500
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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 | N3612
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License Number State | TX
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