North Metro Dermatology PLLC
Organization Active NPI Specialist · North Oaks, MN
NPI 1174863658 · NPPES record last updated Jun 23, 2014
Key facts
- NPI
- 1174863658
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 50109 (MN)
- Legal business name
- NORTH METRO DERMATOLOGY PLLC
- Practice address
- 400 Village Center Dr
Suite 200
North Oaks, MN 55127-7848 - Phone
- (651) 789-9800
- NPI assigned
- Feb 21, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Anudeep Kaur Rahil, M.D.
- Title
- Physcian
- Phone
- (651) 789-9800
Practitioners 5
-
Devi Chettiar, PA-C
-
Bart Theodore Endrizzi, M.D/PH.D.
-
Sherri A Long, MD
-
Anudeep K Rahil, MD
-
Josephine Ann Sauro, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D2061348 | North Metro Dermatology | Compliance | Feb 15, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130723001038 | MN | Part B Supplier - Clinic/Group Practice | 4688815343 |
Receives reassigned benefits from 5 practitioners Practice locations: North Oaks, MN |
National Provider Directory
Locations
400 Village Center Dr
Ste 200
Saint Paul, MN 55127
Phone (651) 789-9800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 50109 | MN | Yes |
Addresses
Primary practice location
400 Village Center Dr
Suite 200
North Oaks, MN 55127-7848
Mailing address
400 Village Center Dr
Suite 200
North Oaks, MN 55127-7848
Phone (651) 789-9800
Other providers in North Oaks, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.