Midwest Clinic of Dermatology Laser and Cosmetic Surgery PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MIDWEST CLINIC OF DERMATOLOGY LASER AND COSMETIC SURGERY PA

Practice address

1510 24TH Ave N
Saint Cloud, MN 56303-1304

Phone

(320) 259-0208

Fax

(320) 259-0715

NPI assigned

Sep 13, 2006

Last updated

Oct 2, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Daniel Kevin Elieff, MDNPI 1891778163

Title

President/Owner

Phone

(320) 259-0208

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Kevin Elieff, MD

  • Dermatology Physician
  • Saint Cloud, MN
  • NPI 1891778163
  Medicare reassignment Care Compare group NPD Authorized official
• Sarah Tasto, APRN-CNP

  • Nurse Practitioner
  • Saint Cloud, MN
  • NPI 1467062133
  Medicare reassignment Care Compare group NPD
• Daniel Leonard Elieff, MD

  • Family Medicine Physician
  • Saginaw, MI
  • NPI 1952969420

  MN

  Medicare reassignment Care Compare group NPD
• Corey Bryce Toay, PA-C

  • Physician Assistant
  • Alexandria, MN
  • NPI 1740827633
  Medicare reassignment Care Compare group
• Kristofer Michael Wallman, MPAS, PA-C

  • Medical Physician Assistant
  • Foley, MN
  • NPI 1962439547
  Medicare reassignment

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412208000000",
    "number": "1811092398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 24TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031304",
            "telephone_number": "320-259-0208",
            "fax_number": "320-259-0715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 24TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031304",
            "telephone_number": "320-259-0208",
            "fax_number": "320-259-0715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST CLINIC OF DERMATOLOGY LASER AND COSMETIC SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2014-10-02",
        "status": "A",
        "authorized_official_last_name": "ELIEFF",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "320-259-0208",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Midpoint Support Services L.L.C.
• Midsota Plastic and Reconstructive Surgeons PA (Midsota Plastic Surgeons)
• Midsota Surgical Suites PA
• Midway Counseling Services LLC
• Midwest Behavioral Healing Center Inc
• Midwest Eap Solutions
• Midwest Eap Solutions
• Midwest Group Homes LLC
• Midwest Respiratory Care Inc.
• Midwest Vision Centers Inc (Midwest Vision Centers)

• Dermatology Physician in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.