Advanced Dermatology Care Medical Cosmetic and Surgery PA

NPI #1912158031 in Forest Lake, Minnesota

Provider Information

NPI Number: 1912158031
Entity Type: Organization
Organization Name: Advanced Dermatology Care Medical Cosmetic and Surgery PA
Primary Specialty: Dermatology
Enumeration Date: Oct 7, 2008
Last Updated: Jan 11, 2010

Practice Location

Address: 25 LAKE ST N
Address 2: SUITE 200
City: Forest Lake
State: Minnesota
ZIP Code: 55025-2535
Phone: (651) 484-2724

Authorized Official

Name: DR. OLAF J RUSTAD, M.D.
Title: DERMATOLOGIST
Phone: (651) 484-2724

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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