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General NPI Number Information
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NPI Number | 1891204285
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Entity Type | Organization
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Legal Business Name | EXCLUSIVELY SKIN LLC
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 9565 MIDWEST AVE STE C
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2421
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Country | US
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Telephone | 216-508-6500
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Fax | 216-508-6501
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Provider Business Mailing Address
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Address Line | 9565 MIDWEST AVE STE C
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2421
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Country | US
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Telephone | 216-508-6500
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Fax | 216-508-6501
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. TRACY LYNETTE RINGO
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Credential | DO
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Telephone | 216-508-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34007796
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License Number State | OH
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