ADVANCED DERMATOLOGY CARE MEDICAL COSMETIC AND SURGERY PA (NPI# 1144486978) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144486978 |
| Entity Type | Organization |
| Organization Name | ADVANCED DERMATOLOGY CARE MEDICAL COSMETIC AND SURGERY PA |
| Other Organization Name | ADVANCED DERMATOLOGY CARE |
| Practice Address |
1970 Northwestern Ave S Suite 300 Stillwater MN 55082 |
| Mailing Address |
4480 Centerville Rd White Bearlake MN 55127 |
| Practice Telephone | 6514302724 |
| Mailing Telephone | 6514842724 |
| Mailing Fax Number | 6514842724 |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2009-03-10 |
| Authorized Official Name | OLAF JONATHAN RUSTAD (DERMATOLOGIST PRESIDENT) |
| Authorized Official Telephone | 6514842724 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 1376 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | PTAN | 070000195 | 01 |
| MN | GROUP LEGACY | C01783 | 01 |
| Other Name | Type Code |
|---|---|
| Advanced Dermatology Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912158031 | Advanced Dermatology Care Medical Cosmetic and Surgery Pa | Dermatology | 25 Lake St N, Suite 200, Forest Lake, MN 55025-2535 | 2008-10-07 |
| 1073614558 | Advanced Dermatology Care Medical Cosmetic and Surgery Pa | Dermatology | 4480 Centerville Rd, White Bear Lake, MN 55127-3674 | 2006-09-26 |
| Street Address |
1970 NORTHWESTERN AVE S SUITE 300 |
| City | STILLWATER |
| State | MN |
| Zip Code | 55082 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558325910 | Total Renal Care Inc | Clinic/Center | 1970 Northwestern Ave S, Stillwater, MN 55082-6567 | 2006-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154947455 | Lucas William Schmidt | Optometrist | 2950 Curve Crest Blvd, Stillwater, Stillwater, MN 55082 | 2020-06-23 |
| 1982238085 | Jerald Haley | Technician | 924 6th Ave. S., Stillwater, MN 55082 | 2020-02-27 |
| 1801457387 | Sun Trad Chin Acu Mn LLC | Acupuncturist | Compass Center for Healing, 116 Chestnut St. E., Stillwater, MN 55082 | 2019-06-25 |
| 1598243990 | Carlson Distinctive Dentistry, Pllc | Dentist | 1701 Curve Crest Blvd W Ste 100, Stillwater, MN 55082 | 2018-07-30 |
| 1073001624 | Lindsay Beth Briggs | Chiropractor | 200 Chestnut St E, Ste 202, Stillwater, MN 55082 | 2018-04-30 |
| 1578932943 | Group Health Plan, Inc | Family Medicine | 921 Greeley Street, Stillwater, MN 55082 | 2015-09-16 |
| 1184001919 | Grant Rohrig | Specialist/Technologist | 8727 Jeffrey Ave North, Stillwater, MN 55082 | 2015-04-30 |
| 1346688991 | Kellie Ann Seth | Chiropractor | 200 Chestnut St E Ste 202, Stillwater, MN 55082 | 2013-06-05 |
| 1770928426 | Rivertown Animal Hospital | Veterinarian | 135 New England Place, Stillwater, MN 55082 | 2013-05-08 |
| 1285929265 | Healtheast Medical Research Institute | Dietitian, Registered | 2900 Curve Crest Blvd, Stillwater, MN 55082 | 2011-06-17 |
| Find all providers in zip 55082 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982775029 | Christine Kay Markus | Dermatology | 1950 Curve Crest Blvd W Ste 100, Stillwater, MN 55082-6062 | 2006-11-12 |
| 1588609606 | Robert Allan Breedlove | Dermatology | 1604 W 8th Ave, Stillwater, OK 74074-4207 | 2006-06-20 |
| 1174578280 | Thomas Carl Hall | Dermatology | 1329 S Sangre Rd, Stillwater, OK 74074-1854 | 2006-05-24 |
| 1881733780 | Sara K Metcalf | Dermatology | 1329 S Sangre Rd, Stillwater, OK 74074-1854 | 2007-02-06 |
| 1467487132 | Stillwater Dermatology Clinic | Dermatology | 1329 S Sangre Rd, Stillwater, OK 74074-1854 | 2006-07-11 |
| 1558350488 | Stillwater Medical Group | Dermatology | 1500 Curve Crest Blvd W, Stillwater, MN 55082-6040 | 2005-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962871608 | Lakes Dermatology, Pa | Dermatology | 14305 Southcross Dr W, Suite 110, Burnsville, MN 55306-7009 | 2015-09-23 |
| 1194133157 | Adam Schmitt | Dermatology | 2 Carlson Pkwy N Ste 240, Plymouth, MN 55447 | 2014-07-22 |
| 1578982773 | Lori Ann Fiessinger | Dermatology | 420 Delaware Street Se, Mmc 98, Minneapolis, MN 55455 | 2014-04-15 |
| 1942629795 | Shane O'neil | Dermatology | 500 Osborne Rd Ne Ste 330, Fridley, MN 55432 | 2014-04-09 |
| 1033537782 | Erin Sellinger | Dermatology | 2 Carlson Pkwy N, Ste 240, Plymouth, MN 55447-4485 | 2014-03-31 |
| 1033555230 | Samuel Blake Ecker | Dermatology | 3655 Plymouth Blvd Ste 110, Minneapolis, MN 55446-3665 | 2013-05-14 |
| 1295078913 | Jessica Jane Newman | Dermatology | 4-240, Phillips-wangensteen Bldg., 516 Delaware Street S.e., Mail Code 98, Minneapolis, MN 55455 | 2013-04-01 |
| 1437416088 | Tiffany Lynn Shih | Dermatology | 401 Phalen Blvd # Ms 41102b, Saint Paul, MN 55130-5302 | 2012-04-20 |
| 1124317383 | Sara Anne Hylwa | Dermatology | 730 South 8th Street, Department of Dermatology, Minneapolis, MN 55415 | 2011-03-28 |
| 1770885360 | Thomas Joseph Kalb | Dermatology | 13420 106th St., Young America, MN 55397-5401 | 2010-12-02 |
| Find all providers with the same taxonomy | ||||
| City | STILLWATER |
| Zip Code | 55082 |
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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.