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Physicians Dermatology MOHS-Micrographic Surgery

Provider NPI: 1013350958

Organization Information:
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


PrimaryCodeCategory/DescriptionStateLicense Number
MOHS-Micrographic Surgery

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207N00000X





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