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Organization

COSMETIC SKIN AND LASER CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GUSTAV JAILING LO M.D. (OWNER)
(231) 347-7395
Entity
Organization

Contact information

Practice address
116 W MITCHELL ST, PETOSKEY, MI 49770-2324
(231) 347-7395
Mailing address
116 W MITCHELL ST, PETOSKEY, MI 49770-2324
(231) 347-7395

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
GL053321
MI

Other

Enumeration date
04/02/2009
Last updated
04/02/2009
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