Provider Demographics
NPI:1154930964
Name:SKINMED INSTITUTE PLLC
Entity type:Organization
Organization Name:SKINMED INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-381-2600
Mailing Address - Street 1:10103 RIDGEGATE PKWY STE 223
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5525
Mailing Address - Country:US
Mailing Address - Phone:720-381-2600
Mailing Address - Fax:720-381-2601
Practice Address - Street 1:10103 RIDGEGATE PKWY STE 223
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5525
Practice Address - Country:US
Practice Address - Phone:720-381-2600
Practice Address - Fax:720-381-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty