NPI | 1013350958 |
---|---|
Entity Type | Organization |
Authorized Contact | KEVAN LEWIS Owner 920-965-0345 |
Organization Subpart ? | No |
Primary Taxonomy | 207N00000X Dermatology |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
207ND0900X Dermatology, Dermatopathology | |
207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology | |
207NP0225X Dermatology, Pediatric Dermatology | |
207NS0135X Dermatology, Procedural Dermatology | |
Enumeration Date | 2013-04-10 |
Last Update Date | 2013-04-10 |