NPIMap

Organization Active NPI

Cosmetic Skin and Laser Center

  • General Practice Physician
  • Petoskey, MI
National Provider Identifier
1811139082
Registry record updated Apr 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
GL053321 Issued in MI
Legal business name
COSMETIC SKIN AND LASER CENTER
Practice address
116 W Mitchell St
Petoskey, MI 49770-2324
Phone
(231) 347-7395
NPI assigned
Apr 2, 2009
Last updated
Apr 2, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2009

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

Authorized official

Name
Gustav Jailing Lo, M.D.NPI 1568519635
Title
Owner
Phone
(231) 347-7395

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X GL053321 MI Primary

Addresses

Primary practice location

116 W Mitchell St
Petoskey, MI 49770-2324

Mailing address

116 W Mitchell St
Petoskey, MI 49770-2324
Phone (231) 347-7395

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238630400000",
    "number": "1811139082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 W MITCHELL ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702324",
            "telephone_number": "231-347-7395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 W MITCHELL ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702324",
            "telephone_number": "231-347-7395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMETIC SKIN AND LASER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-02",
        "last_updated": "2009-04-02",
        "status": "A",
        "authorized_official_last_name": "LO",
        "authorized_official_first_name": "GUSTAV",
        "authorized_official_middle_name": "JAILING",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-347-7395",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "GL053321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.