MEDICARE: SVC DERMATOLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0B514150	OTHER	MI	BLUE CROSS MICHIGAN

General Provider Information

NPI Number	:	1174565600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SVC DERMATOLOGY PC

Provider Business Mailing Address
First Line	:	305 N LEROY ST
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2729
Country	:	US
Telephone Number	:	810-629-0336
Fax Number	:	810-629-7251

Provider Business Practice Location Address
First Line	:	305 N LEROY ST
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2729
Country	:	US
Telephone Number	:	810-629-0336
Fax Number	:	810-629-7251

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC SCOTT SEIGER
Credential	:	DO
Telephone Number	:	810-629-0336

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/21/2022

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Directions to “SVC DERMATOLOGY PC ” Practice Location

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