Provider Demographics
NPI:1902967375
Name:DERMATOLOGY CLINIC OF SOUTH FLORIDA PA
Entity Type:Organization
Organization Name:DERMATOLOGY CLINIC OF SOUTH FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MIKESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-775-3535
Mailing Address - Street 1:694 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5523
Mailing Address - Country:US
Mailing Address - Phone:239-775-3535
Mailing Address - Fax:239-775-3636
Practice Address - Street 1:694 8TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5523
Practice Address - Country:US
Practice Address - Phone:239-775-3535
Practice Address - Fax:239-775-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87847207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81413OtherBLUE CROSS PROVIDER NUMBE
FLK8700Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER