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General NPI Number Information
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NPI Number | 1538193602
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Entity Type | Organization
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Legal Business Name | HEARTLAND DERMATOLOGY
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 200 E HIGHLAND BLVD
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City | WATERTOWN
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State | SD
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Zip | 57201
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Country | US
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Telephone | 605-882-3343
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Fax | 605-882-4167
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Provider Business Mailing Address
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Address Line | 200 E HIGHLAND BLVD
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City | WATERTOWN
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State | SD
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Zip | 57201
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Country | US
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Telephone | 605-882-3343
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Fax | 605-882-4167
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Authorized Official
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Title or Position | PRESIDENT
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Name | IAN ANDREW WHITCROFT
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Credential | MD
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Telephone | 605-882-4129
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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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