Advanced Dermatology Care Medical Cosmetic and Surgery PA
NPI 1073614558ActiveOrganization· Dermatology· White Bear Lake, MN
Dermatology in White Bear Lake, Minnesota, registered in NPPES in September 2006, part of Advanced Dermatology Care Medical and Surgical Dermatology PA. The authorized official on file is Olaf J. Rustad, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1073614558 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Advanced Dermatology Care Medical and Surgical Dermatology PA |
| NPI issued | Sep 26, 2006 |
| Last updated in NPPES | Nov 16, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MN) |
|---|
Other Dermatology providers in White Bear Lake
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