Provider Demographics
NPI:1063588572
Name:GROSSE POINTE DERMATOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:GROSSE POINTE DERMATOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-886-2600
Mailing Address - Street 1:16815 E JEFFERSON AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1923
Mailing Address - Country:US
Mailing Address - Phone:313-886-2600
Mailing Address - Fax:313-886-2099
Practice Address - Street 1:16815 E JEFFERSON AVE STE 260
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1923
Practice Address - Country:US
Practice Address - Phone:313-886-2600
Practice Address - Fax:313-886-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty