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General NPI Number Information
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NPI Number | 1649921834
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Entity Type | Organization
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Legal Business Name | SKIN CARE EXPERTS LLC
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 900 W SOUTH BOUNDARY ST BLDG 9
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City | PERRYSBURG
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State | OH
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Zip | 43551-5230
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Country | US
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Telephone | 419-873-6963
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Fax | 419-873-6964
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Provider Business Mailing Address
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Address Line | 900 W SOUTH BOUNDARY ST BLDG 9A
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City | PERRYSBURG
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State | OH
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Zip | 43551-5245
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Country | US
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Telephone | 419-873-6963
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Fax | 419-873-6964
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | ABDEL KADER TAL
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Credential | MD
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Telephone | 419-320-3777
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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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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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