MEDICARE: SKIN PERFECTION OF SOUTHFIELD, PLLC

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

General Provider Information

NPI Number	:	1285809954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKIN PERFECTION OF SOUTHFIELD, PLLC

Provider Business Mailing Address
First Line	:	26411 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4528
Country	:	US
Telephone Number	:	248-424-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	26411 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-4528
Country	:	US
Telephone Number	:	248-424-8000
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. STEVEN K GREKIN
Credential	:	D.O.
Telephone Number	:	248-705-9102

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	04/24/2008

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