Organization
CLEAR THE DERMATOLOGY CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY RACIGNOL (BILLING COORDINATOR)
(231) 348-2828
Entity
Organization
Contact information
Practice address
116 W MITCHELL ST, PETOSKEY, MI 49770-2357
(231) 348-0766
Mailing address
116 W MITCHELL ST, PETOSKEY, MI 49770-2357
(231) 348-0766
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
4301053221
MI
363AM0700X
Medical Physician Assistant
Primary
5601004147
MI
Other
Enumeration date
07/08/2016
Last updated
08/02/2016
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