Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 55882 | MN |
N | 207ND0101X | MOHS-Micrographic Surgeon | 55882 | MN |
N | 207ND0900X | Dermatopathologist | 55882 | MN |
NPI | 1235340894 |
---|---|
Provider Name | Dr. Kamruz Darabi |
First Address | Waconia, MN 55387-4578 |
Second Address | Waconia, MN 55387-4578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 21/12/2021 |