Organization
ADVANCED DERMATOLOGY AND COSMETIC SURGERY LLC
Active
Organization
ADVANCED DERMATOLOGY AND COSMETIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN MICHAEL CRAWFORD M.D. (DERMATOLOGIST)
(812) 358-7705
Entity
Organization
Contact information
Practice address
303 S WALNUT ST, SEYMOUR, IN 47274-2368
(812) 358-7705
Mailing address
PO BOX 1077, SEYMOUR, IN 47274-1077
(812) 358-7705
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
01063019A
IN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
01063019A
IN
207NS0135X
Procedural Dermatology Physician
01063019A
IN
Other
Enumeration date
05/28/2008
Last updated
08/08/2011
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