Organization
MADISON DERMATOLOGY LLC
Active
Other names
skin solutions llc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDUARDO GABRIEL RIVERA M.D. (OWNER)
(812) 265-9191
Entity
Organization
Contact information
Practice address
122 DEMAREE DR, MADISON, IN 47250-4622
(812) 265-9191
(812) 265-1050
Mailing address
122 DEMAREE DR, MADISON, IN 47250-4622
(812) 265-9191
(812) 265-1050
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D0952312
CLIA FOR MADISON LOCATION
IN
01
—
15D1048313
CLIA FOR COLUMBUS LOCATIO
IN
Enumeration date
11/08/2006
Last updated
03/27/2013
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