| NPI | 1538734066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE L ANGER Sr. Director, Provider Enrollment 920-663-9022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207NS0135X Dermatology Procedural Dermatology | |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2021-05-26 |