Organization
LAZADERM SKIN CARE CENTRE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORNELL E HANSEN II MD (PROVIDER AND OWNER)
(605) 275-6128
Entity
Organization
Contact information
Practice address
5011 S LOUISE AVE, SIOUX FALLS, SD 57108-2268
(605) 275-6128
(605) 373-9971
Mailing address
PO BOX 5126, SIOUX FALLS, SD 57117-5126
(605) 335-1952
(605) 373-9971
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO9926
RAILROAD MEDICARE
SD
Enumeration date
12/04/2008
Last updated
12/29/2010
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