NPIMap

Organization Active NPI

Skin Specialists, LTD.

  • Dermatology Physician
  • Minneapolis, MN
National Provider Identifier
1013921600
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
112 Issued in MN
Legal business name
SKIN SPECIALISTS, LTD.
Practice address
825 Nicollet Mall
Suite 1002
Minneapolis, MN 55402-2606
Phone
(612) 338-0711
Fax
(612) 332-3663
NPI assigned
Jul 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alvin Sheldon Zelickson, M.D.
Title
President
Phone
(612) 338-0711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 112 MN Primary

Addresses

Primary practice location

825 Nicollet Mall
Suite 1002
Minneapolis, MN 55402-2606

Mailing address

825 Nicollet Mall
Suite 1002
Minneapolis, MN 55402-2606
Phone (612) 338-0711

National Provider Directory

National Provider Directory

Locations

825 Nicollet Mall
Ste 100
Minneapolis, MN 55402

825 Nicollet Mall
Ste 1002
Minneapolis, MN 55402
Phone (612) 338-0711

2 Carlson Pkwy N
Ste 100
Plymouth, MN 55447
Phone (952) 473-1286

2 Carlson Pkwy N
Ste 240
Plymouth, MN 55447
Phone (618) 961-1950

6425 Nicollet Ave
Ste 202
Richfield, MN 55423
Phone (612) 338-0711

250 Central Ave N
Ste 109
Wayzata, MN 55391
Phone (952) 473-1286

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013921600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 NICOLLET MALL",
            "address_2": "SUITE 1002",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554022606",
            "telephone_number": "612-338-0711",
            "fax_number": "612-332-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 NICOLLET MALL",
            "address_2": "SUITE 1002",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554022606",
            "telephone_number": "612-338-0711",
            "fax_number": "612-332-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN SPECIALISTS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ZELICKSON",
        "authorized_official_first_name": "ALVIN",
        "authorized_official_middle_name": "SHELDON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-338-0711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MN",
            "license": "112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.