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General NPI Number Information
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NPI Number | 1851516397
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Entity Type | Organization
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Legal Business Name | SKIN CARE DOCTORS, P.A.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 14000 NICOLLET AVE STE 304
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City | BURNSVILLE
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State | MN
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Zip | 55337-5784
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Country | US
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Telephone | 952-898-1600
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Fax | 952-898-2645
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Provider Business Mailing Address
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Address Line | 14000 NICOLLET AVE STE 304
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City | BURNSVILLE
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State | MN
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Zip | 55337-5784
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Country | US
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Telephone | 952-898-1600
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Fax | 952-898-2645
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL J EBERTZ
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Credential | M.D.
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Telephone | 952-898-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | MN
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