| NPI | 1194462382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE ANGER Sr Director, Provider Enrollment 920-663-9022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2022-05-18 |