Organization
SKIN & MOHS SURGERY CENTER, LLC
Active
Parent organization
OLIVER STREET DERMATOLOGY HOLDINGS
Organization subpart
Yes
Provider details
NPI number
Legal business name
OLIVER STREET DERMATOLOGY HOLDINGS
Authorized official
DR. GLENN D GOLDSTEIN M.D. (MEDICAL DIRECTOR)
(913) 451-7546
Entity
Organization
Contact information
Practice address
11550 GRANADA ST, LEAWOOD, KS 66211-1453
(913) 451-7546
Mailing address
11550 GRANADA ST, LEAWOOD, KS 66211-1453
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
S046023
KS
Other
Enumeration date
09/14/2006
Last updated
04/27/2026
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