Organization
MAIN STREET DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENZIE GARDNER NP (NURSE PRACTITIONER, OPERATOR)
(614) 507-3765
Entity
Organization
Contact information
Practice address
5885 S MAIN ST STE 1, CLARKSTON, MI 48346-2981
(248) 238-8059
Mailing address
5885 S MAIN ST STE 1, CLARKSTON, MI 48346-2981
(248) 238-8059
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
06/30/2023
Last updated
08/03/2023
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