MEDICARE: INFINITY SKIN CARE & SPA LLC

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	:	1699070318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY SKIN CARE & SPA LLC

Provider Business Mailing Address
First Line	:	1100 5TH ST STE 125
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2934
Country	:	US
Telephone Number	:	319-337-5355
Fax Number	:	319-337-5361

Provider Business Practice Location Address
First Line	:	1100 5TH ST STE 125
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2934
Country	:	US
Telephone Number	:	319-337-5355
Fax Number	:	319-337-5361

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KIMBERLY K SCHULZ
Credential	:	M.D.
Telephone Number	:	319-337-5355

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	01/21/2011

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Directions to “INFINITY SKIN CARE & SPA LLC ” Practice Location

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