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General NPI Number Information
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NPI Number | 1518690296
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Entity Type | Organization
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Legal Business Name | DERMIO DERMATOLOGY, LLC
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 14785 W 101ST AVE STE 206
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City | DYER
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State | IN
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Zip | 46311-3371
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Country | US
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Telephone | 219-228-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 CALUMET AVE STE 203
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City | MUNSTER
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State | IN
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Zip | 46321-2885
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/LEAD PHYSICIAN
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Name | ARMAN DAVID SOLEYMANI
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Credential |
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Telephone | 219-228-4200
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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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