Photodermic Skin Therapy, LLC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

PHOTODERMIC SKIN THERAPY, LLC

Practice address

3833 N Meridian St Ste 10
Indianapolis, IN 46208-4001

Phone

(317) 926-4687

NPI assigned

Apr 9, 2008

Organization subpart

No

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

Authorized official

Name

Doug Wregge

Title

Owner

Phone

(317) 283-8113

Specialties & licenses 1

Addresses

Practitioners 1

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

• Elpidio M Feliciano Jr., M.D.

  • Internal Medicine Physician
  • Muncie, IN
  • NPI 1659358745
  NPD (past)

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207699200000",
    "number": "1982877015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3833 N MERIDIAN ST STE 10",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462084001",
            "telephone_number": "317-926-4687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 N MERIDIAN ST STE 10",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462084001",
            "telephone_number": "317-926-4687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOTODERMIC SKIN THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "last_updated": "2008-04-09",
        "status": "A",
        "authorized_official_last_name": "WREGGE",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-283-8113"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael Phung
• Connor Schimmel Phutawon, MD
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• Physical Therapy Specialists, LLC

• Procedural Dermatology Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Procedural Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2008; 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.