Provider Demographics
NPI:1649300880
Name:SKIN CARE PHYSICIANS PC
Entity type:Organization
Organization Name:SKIN CARE PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYAD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ABROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-852-1900
Mailing Address - Street 1:6632 TELEGRAPH RD # 348
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3012
Mailing Address - Country:US
Mailing Address - Phone:248-852-1900
Mailing Address - Fax:248-852-1919
Practice Address - Street 1:110 SOUTH BLVD W STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5184
Practice Address - Country:US
Practice Address - Phone:248-852-1900
Practice Address - Fax:248-852-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P43840Medicare PIN