Provider Demographics
NPI:1366618522
Name:DERMAGENESIS MEDSPA, INC.
Entity type:Organization
Organization Name:DERMAGENESIS MEDSPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SCHEUERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-820-3377
Mailing Address - Street 1:2700 SW 194TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2483
Mailing Address - Country:US
Mailing Address - Phone:305-820-3377
Mailing Address - Fax:305-820-3388
Practice Address - Street 1:2700 SW 194TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2483
Practice Address - Country:US
Practice Address - Phone:305-820-3377
Practice Address - Fax:305-820-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10159204D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty