DERMATOLOGY CENTER FOR CHILDREN & YOUNG ADULTS PA (NPI# 1053417055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053417055 |
| Entity Type | Organization |
| Organization Name | DERMATOLOGY CENTER FOR CHILDREN & YOUNG ADULTS PA |
| Practice Address |
2795 Pilot Knob Rd Suite 300 Eagan MN 55121-1176 |
| Practice Telephone | 6513799999 |
| Practice Fax Number | 6513799900 |
| Mailing Telephone | 6513799999 |
| Mailing Fax Number | 6513799900 |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | KENNETH E BLOOM (PRESIDENT) |
| Authorized Official Telephone | 6513799999 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 013837 | 05 | |
| BLUE CROSS BLUE SHIELD | 2M741DE | 01 |
| Street Address |
2795 PILOT KNOB RD SUITE 300 |
| City | EAGAN |
| State | MN |
| Zip Code | 55121-1176 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164442638 | Sandra Mary Oehlke | Nurse Practitioner | 2795 Pilot Knob Rd, Suite 300, Eagan, MN 55121-1176 | 2006-07-20 |
| 1982235180 | Ciera Shanaye Keyes | Pharmacy Technician | 2795 Pilot Knob Rd, Eagan, MN 55121-1176 | 2020-01-28 |
| 1922647833 | Emanga Ekinde | Pharmacist | 2795 Pilot Knob Rd, Eagan, MN 55121-1176 | 2019-12-26 |
| 1124666961 | Amber Lynn Kaye | Pharmacy Technician | 2795 Pilot Knob Rd, Eagan, MN 55121-1176 | 2019-12-11 |
| 1134778442 | Marissa Ann Finucane | Pharmacy Technician | 2795 Pilot Knob Rd, Eagan, MN 55121-1176 | 2019-09-09 |
| 1821645425 | Rhiannon Nicole Tofaha | Pharmacy Technician | 2795 Pilot Knob Rd, Eagan, MN 55121-1176 | 2019-08-20 |
| 1417513680 | Catherine Nicole Jenkins | Pharmacy Technician | 2795 Pilot Knob Rd, Eagan, MN 55121-1176 | 2019-05-14 |
| 1629634936 | Michele Christen Mask | Pharmacy Technician | 2795 Pilot Knob Rd, Eagan, MN 55121-1176 | 2019-05-13 |
| 1457817207 | Christine Garcia | Pharmacy Technician | 2795 Pilot Knob Rd, Eagan, MN 55121-1176 | 2019-02-18 |
| 1972067866 | Mindi Steffens | Pharmacy Technician | 2795 Pilot Knob Rd, Eagan, MN 55121-1176 | 2019-01-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205443850 | Birchwood Dental, LLC | Dentist | 3356 Sherman Crt Ste 101, Eagan, MN 55121 | 2020-09-28 |
| 1811552813 | Clare Muyskens | Physical Therapist | 3305 Central Park Commons Dr, Eagan, MN 55121 | 2019-05-06 |
| 1154986479 | Elp Right Living Health LLC | Assisted Living Facility | 3035 Eagandale Pl #101, Eagan, MN 55121 | 2019-05-02 |
| 1467908699 | Hy Vee Inc | Pharmacy | 1500 Central Park Commons Drive, Eagan, MN 55121 | 2016-08-28 |
| 1962861005 | Lakeline Transportation LLC | Non-emergency Medical Transport (VAN) | 1416 Shoreline Dr, Eagan, MN 55121 | 2016-02-17 |
| 1467838615 | John Berchem | Physical Therapist | 1284 Coporate Center Drive, #500, Eagan, MN 55121 | 2015-08-10 |
| 1730426099 | Carole P Cohen | Occupational Therapist | 880 Blue Gentian Road, Ste # 190, Eagan, MN 55121 | 2013-01-07 |
| 1407102882 | Emergency Physicians Professional Association | Clinic/Center | 3010 Denmark Avenue, Eagan, MN 55121 | 2012-08-03 |
| 1851692289 | Eagan Family Chiropractic & Massage | Chiropractor | 1260 Yankee Doodle Road, Suite 100, Eagan, MN 55121 | 2010-11-17 |
| 1780805218 | Bridget Marie Mcconnell | Social Worker | 680 O'neill Drive, Eagan, MN 55121 | 2007-05-01 |
| Find all providers in zip 55121 | ||||
| Taxonomy Code | 207NP0225X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Pediatric Dermatology |
| A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: changed definition, added source] Additional Resources: American Board of Dermatology, 2007, http://www.abderm.org/ A subspecialty certificate was approved by ABMS in 2000. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619381381 | Cynthia Lynn Nicholson | Dermatology | 2450 Riverside Ave, Minneapolis, MN 55454-1450 | 2014-06-20 |
| 1992976716 | Ingrid C Polcari | Dermatology | 2450 Riverside Ave, 12th Floor Explorer Clinic, Minneapolis, MN 55454-1450 | 2008-03-19 |
| 1679796429 | Sheilagh M Maguiness | Dermatology | 14500 99th Ave N, Maple Grove, MN 55369-4730 | 2007-04-10 |
| 1053465641 | Kristen Paige Hook | Dermatology | 2450 Riverside Ave, Clinic 12e, Minneapolis, MN 55454-1450 | 2007-01-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.