MEDICARE: SOMERSET SKIN CENTRE

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	207ND0101X	MOHS-Micrographic Surgery Physician	GM077180	MI

General Provider Information

NPI Number	:	1811087075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMERSET SKIN CENTRE

Provider Business Mailing Address
First Line	:	255 KIRTS BLVD
Second Line	:	SUITE 100
City	:	TROY
State	:	MI
Zip	:	48084-5260
Country	:	US
Telephone Number	:	248-244-8448
Fax Number	:	248-244-8766

Provider Business Practice Location Address
First Line	:	255 KIRTS BLVD
Second Line	:	SUITE 100
City	:	TROY
State	:	MI
Zip	:	48084-5260
Country	:	US
Telephone Number	:	248-244-8448
Fax Number	:	248-244-8766

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GEORGE MURAKAWA
Credential	:	MD
Telephone Number	:	248-244-8448

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	10/29/2007

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Directions to “SOMERSET SKIN CENTRE ” Practice Location

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