COSMETIC SKIN AND LASER CENTER (NPI# 1811139082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811139082 |
| Entity Type | Organization |
| Organization Name | COSMETIC SKIN AND LASER CENTER |
| Practice Address |
116 W Mitchell St Petoskey MI 49770-2324 |
| Practice Telephone | 2313477395 |
| Mailing Telephone | 2313477395 |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2009-04-02 |
| Authorized Official Name | GUSTAV JAILING LO (OWNER) |
| Authorized Official Telephone | 2313477395 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | GL053321 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
116 W MITCHELL ST |
| City | PETOSKEY |
| State | MI |
| Zip Code | 49770-2324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659438976 | Patricia Elizabeth Kelly | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2007-01-03 |
| 1265071211 | Whitney Marie Warner | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2357 | 2019-12-21 |
| 1699268805 | Spencer Cross | Nurse Practitioner | 116 W Mitchell St, Petoskey, MI 49770-2357 | 2018-06-12 |
| 1568980787 | Ariana Spiewak | Nurse Practitioner | 116 W Mitchell St, Petoskey, MI 49770-2357 | 2017-09-08 |
| 1124546684 | Amy Burns | Nurse Practitioner | 116 W Mitchell St, Petoskey, MI 49770-2357 | 2017-09-05 |
| 1164874616 | Clear The Dermatology Clinic PC | General Practice | 116 W Mitchell St, Petoskey, MI 49770-2357 | 2016-07-08 |
| 1124410626 | Marisa Rhein | Nurse Practitioner | 116 W Mitchell St, Petoskey, MI 49770-2357 | 2015-02-21 |
| 1740520980 | Chelsea Navarro | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2357 | 2013-02-26 |
| 1336456102 | Ryan Planck | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2010-09-01 |
| 1346406592 | Courtney Griffith-sumpter | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2008-08-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780231985 | Olivia Michelle Seaman | Pharmacist | 1301 U.S. 31 N. Hwy, Petoskey, MI 49770 | 2019-08-22 |
| 1649733148 | Harbor Hall, Inc. | Clinic/Center | 302 Orchard Ridge Drive, Petoskey, MI 49770 | 2019-04-11 |
| 1053802942 | Devin Hueston | Dentist | 231 State St Ste 3, Petoskey, MI 49770 | 2018-05-25 |
| 1720585037 | Jacob Kenneth Tracy | Counselor | 410 E Lake Street, Suite 100, Petoskey, MI 49770 | 2018-04-12 |
| 1013424191 | Timothy Robert La Gasse | Nurse Practitioner | 401 Connable Ave, Petoskey, MI 49770 | 2018-01-10 |
| 1609303676 | Shauna Sue Stark | Nurse Practitioner | 560 W Mitchell St Ste 505, Petoskey, MI 49770 | 2017-05-22 |
| 1053851519 | Maureen Todd | Counselor | 703 Emmet St, Petoskey, MI 49770 | 2017-03-03 |
| 1457719239 | Hufford Vision & Eye Care, PC | Optometrist | 560 West Mitchell, Suite 214, Petoskey, MI 49770 | 2016-02-08 |
| 1053779439 | Kaylyn Schiemann | Specialist/Technologist | 1980 Maxwell Rd, Petoskey, MI 49770 | 2016-02-01 |
| 1669839130 | Stieber Pediatric Dentistry Pllc | Clinic/Center | 1605 Us 131 Highway, Petoskey, MI 49770 | 2016-01-28 |
| Find all providers in zip 49770 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881908671 | Russell Frederick Labeau Jr. | General Practice | 402 Rolling Hills Ln, Petoskey, MI 49770-9602 | 2010-08-04 |
| 1164874616 | Clear The Dermatology Clinic PC | General Practice | 116 W Mitchell St, Petoskey, MI 49770-2357 | 2016-07-08 |
| 1518145309 | Quick Care Family Medical Center PC | General Practice | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2008-02-05 |
| 1568519635 | Gustav Jaliang Lo | General Practice | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2007-01-04 |
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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.