Organization
MANISTEE DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE DAWN NEIDER MD (DOCTOR)
(231) 398-1700
Entity
Organization
Contact information
Practice address
1293 E PARKDALE AVE, SUITE 2500, MANISTEE, MI 49660-8904
(231) 398-1700
(231) 398-1709
Mailing address
2138 RELIABLE PKWY, CHICAGO, IL 60686-0001
(231) 398-1700
(231) 398-1709
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
4301086785
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104819846
—
MI
Enumeration date
07/10/2007
Last updated
02/10/2012
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