Provider Demographics
NPI:1043249865
Name:SKINSPEAKS: ADVANCEMENTS IN DERMATOLOGY AND SPA M.D., P.A.
Entity type:Organization
Organization Name:SKINSPEAKS: ADVANCEMENTS IN DERMATOLOGY AND SPA M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-231-8710
Mailing Address - Street 1:7373 FRANCE AVE S STE 110
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4538
Mailing Address - Country:US
Mailing Address - Phone:763-231-8700
Mailing Address - Fax:763-231-8711
Practice Address - Street 1:7373 FRANCE AVE S STE 110
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:763-231-8700
Practice Address - Fax:763-231-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116815OtherUCARE
MN34204CAOtherBCBS
MN34204CAOtherBCBS