Provider Demographics
NPI:1871995324
Name:SKIN CANCER & COSMETIC DERMATOLOGY CENTER
Entity type:Organization
Organization Name:SKIN CANCER & COSMETIC DERMATOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LATOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:2696-601-6710
Mailing Address - Street 1:7070 E DRIVE NORTH
Mailing Address - Street 2:C/O DSSC
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014
Mailing Address - Country:US
Mailing Address - Phone:269-660-1670
Mailing Address - Fax:269-660-0666
Practice Address - Street 1:306 E MAUMEE ST
Practice Address - Street 2:SUITE 301 - CAMERON MEDICAL OFFICE BUILDING
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2038
Practice Address - Country:US
Practice Address - Phone:269-660-1670
Practice Address - Fax:269-660-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074279A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty