Organization
ADVANCED DERMATOLOGY OF MICHIGAN, PC
Active
Organization
ADVANCED DERMATOLOGY OF MICHIGAN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY DECLUE (DIRECTOR, PROVIDER SERVICES)
(407) 875-2080
Entity
Organization
Contact information
Practice address
13450 E 12 MILE RD, WARREN, MI 48088-3671
(586) 759-5525
(586) 759-4022
Mailing address
151 SOUTHHALL LN, STE 300, MAITLAND, FL 32751-7176
(407) 875-2080
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
01/30/2015
Last updated
01/30/2015
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