Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Acne, Skin Disease & Leg Vein Clinic, PA

Organization Dermatology Physician · NPI 1417163189

Acne, Skin Disease & Leg Vein Clinic, PA is a Dermatology Physician in Coon Rapids, Minnesota. Registered with an NPI since 2007.

In the registry since
2007
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3960 Coon Rapids Blvd NW Ste 116
Coon Rapids, MN 55433-2569
Phone: (763) 427-8113
Fax: (763) 427-8131
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1417163189
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Theodore Buselmeier — President · (763) 427-8113
NPI enumeratedMay 16, 2007
Last updated in NPPESAugust 7, 2008
Mailing address3960 Coon Rapids Blvd Nw, Suite 116, Coon Rapids, MN 55433-2569

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