| NPI | 1356784334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVAN LEWIS Owner 920-965-0345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 53110-20) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 53110-20) |
| 207ND0900X Dermatology, Dermatopathology (Licence: WI 53110-20) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: WI 53110-20) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WI 53110-20) | |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2013-04-09 |