MEDICARE: SILVERTON SKIN INSTITUTE 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	5101009273	MI

General Provider Information

NPI Number	:	1417090317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVERTON SKIN INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	3495 S CENTER RD
Second Line	:
City	:	BURTON
State	:	MI
Zip	:	48519-1455
Country	:	US
Telephone Number	:	810-424-2007
Fax Number	:	810-743-1099

Provider Business Practice Location Address
First Line	:	8245 HOLLY RD
Second Line	:	SUITE 101
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2443
Country	:	US
Telephone Number	:	810-606-7500
Fax Number	:	810-606-9600

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBALL SILVERTON
Credential	:	DO
Telephone Number	:	810-424-2007

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	09/20/2007

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Directions to “SILVERTON SKIN INSTITUTE PLLC ” Practice Location

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