| NPI | 1083485510 |
|---|---|
| Doing Business As | LAKESHORE DERMATOLOGY LASER & MEDICAL SPA, A FOREFRONT DERMATOLOGY PR |
| Entity Type | Organization |
| Authorized Contact | BETSY J WERNLI President 920-482-0671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2024-01-12 |