| NPI | 1124730312 |
|---|---|
| Doing Business As | LAKESIDE DERMATOLOGY, A FOREFRONT DERMATOLOGY PRACTICE |
| 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 |
| 207NS0135X Dermatology, Procedural Dermatology | |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2023-01-10 |