MEDICARE: SKIN IN THE GAME, 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	909605	OTHER	MS	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760043046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKIN IN THE GAME, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 6625
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39506-6625
Country	:	US
Telephone Number	:	228-864-3300
Fax Number	:	228-864-3333

Provider Business Practice Location Address
First Line	:	6510 HIGHWAY 90
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5015
Country	:	US
Telephone Number	:	228-864-3300
Fax Number	:	228-864-3333

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	HOLLY HARLAN
Credential	:
Telephone Number	:	228-864-3300

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	02/24/2023

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Directions to “SKIN IN THE GAME, PLLC ” Practice Location

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