Great Lakes Dermatology in Kenosha - Procedural Dermatology
Great Lakes Dermatology - NPI 1558576322
Great Lakes Dermatology is a Procedural Dermatology in Kenosha, Wisconsin. Great Lakes Dermatology practices all healthcare services and medical treatments related to Procedural Dermatology. The NPI Number for Great Lakes Dermatology is 1558576322. The last update date is 2020-08-22.
Great Lakes Dermatology's current location address is 3601 30th Ave, Kenosha, Wisconsin. You can contact this provider via phone number 2626582594. The mailing address for Great Lakes Dermatology is 3601 30th Ave, Kenosha, Wisconsin. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Great Lakes Dermatology |
|---|---|
| Address | 3601 30th Ave, Kenosha, Wisconsin |
| Phone Number | 2626582594 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | ADMINISTRA |
|---|---|
| Authorized Official Name | Dean Cathy |
| Telephone Number | 8004858640 |
NPI Number Detail
| NPI Number | 1558576322 |
|---|---|
| Provider Enumeration Date | 2007-05-14 |
| Last Updated Date | 2020-08-22 |
Provider Mailing Address Detail
| Address | 3601 30th Ave |
|---|---|
| City | Kenosha |
| State | Wisconsin (WI) |
| Post Code | 531441695 |
| Phone Number | 2626582594 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Procedural Dermatology |
|---|---|
| Taxonomy | 207Ns0135X |
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Definition: Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surge |
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What is the unique 10-digit identifier code issued to Great Lakes Dermatology by the Centers for Medicare & Medicaid Services?
The Great Lakes Dermatology has been assigned the NPI (National Provider Identifier) 1558576322 by the CMS (Centers for Medicare & Medicaid Services). This 10-digit code serves as a unique identification number for healthcare providers.
Could you share the physical location details of Great Lakes Dermatology?
The Great Lakes Dermatology is situated at 3601 30Th Ave, in the city of Kenosha, state of WI, with the zip code 531441695.
What is Great Lakes Dermatology's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Great Lakes Dermatology's specialized field of practice is Procedural Dermatology, and the corresponding taxonomy code that categorizes this area of specialization is 207Ns0135X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1558576322 to Great Lakes Dermatology?
The Centers for Medicare & Medicaid Services originally issued the 1558576322 to Great Lakes Dermatology on 2007-05-14.
When was the Great Lakes Dermatology's information last updated?
The Great Lakes Dermatology's information was last updated on 2020-08-22.
NPI Number: 1336142389
Address: Po Box 2004, East Syracuse, NY