Organization
MACINNIS DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN MACINNIS M.D. (OWNER)
(352) 350-5230
Entity
Organization
Contact information
Practice address
27950 US HIGHWAY 27, LEESBURG, FL 34748-9050
(352) 350-5230
(866) 539-7193
Mailing address
PO BOX 490558, LEESBURG, FL 34749-0558
(352) 350-5230
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
ME100399
FL
Other
Enumeration date
01/04/2010
Last updated
03/17/2018
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