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General NPI Number Information
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NPI Number | 1588877104
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY LASER CENTER, LLC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 15 E 11TH ST
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City | LIBERAL
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State | KS
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Zip | 67901-2720
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Country | US
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Telephone | 620-624-9100
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Fax | 620-624-9107
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Provider Business Mailing Address
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Address Line | 15 E 11TH ST
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City | LIBERAL
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State | KS
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Zip | 67901-2720
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Country | US
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Telephone | 620-624-9100
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Fax | 620-624-9107
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAREK J KAMINSKI
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Credential | MD
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Telephone | 620-624-9100
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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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