Provider Demographics
NPI:1154575140
Name:MINNESOTA SKIN CONSULTANTS, LLC
Entity type:Organization
Organization Name:MINNESOTA SKIN CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-216-1500
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:SUITE 735
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2606
Mailing Address - Country:US
Mailing Address - Phone:612-216-1500
Mailing Address - Fax:612-216-2089
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 735
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:612-216-1500
Practice Address - Fax:612-216-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35804261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF41976Medicare UPIN
MN307019100Medicare UPIN