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NEW DERMATOLOGY GROUP LTD

Physicians Dermatology MOHS-Micrographic Surgery

Provider NPI: 1013350958

Organization Information:
Organization Name:  NEW DERMATOLOGY GROUP LTD
Organization is not Subpart
Authorized Official:  KEVAN  LEWIS  OWNER  920-965-0345

Practice Location:
704 S WEBSTER AVE  GREEN BAY, WI 54301-3528 US
Tel: 920-965-0345  Fax: 920-273-6011

Business Mailing Address:
2221 S WEBSTER AVE STE 241 GREEN BAY, WI 54301-2158 US
Tel: 920-965-0345  Fax: 920-273-6011

NPI Information:
NPI: 1013350958
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N207ND0101XPhysicians
Dermatology
MOHS-Micrographic Surgery
N207ND0900XPhysicians
Dermatology
N207NI0002XPhysicians
Dermatology
N207NP0225XPhysicians
Dermatology
N207NS0135XPhysicians
Dermatology
Y207N00000XPhysicians
Dermatology

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 207N00000X

Type:

Classification:



Definition:



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