GREAT LAKES DERMATOLOGY – NPI #1558576322
Dermatology

Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).

GREAT LAKES DERMATOLOGY is a dermatologist located in KENOSHA, WI. NPPES has assigned the NPI number 1558576322 to GREAT LAKES DERMATOLOGY on May 14, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 207NS0135X from the Health Care Provider Taxonomy code set, which is classified as Dermatology, specializing in Procedural Dermatology

The NPI profile was previously updated about 6 years ago on Aug 22, 2020. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for GREAT LAKES DERMATOLOGY below.

NPI Profile for
GREAT LAKES DERMATOLOGY

NPI Number
1558576322
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
GREAT LAKES DERMATOLOGY
Primary location
3601 30TH AVE
SUITE 210
KENOSHA, WI 53144-1695
Phone: (262) 658-2594 Fax:
Mailing address
3610 30TH AVENUE
SUITE 210
KENOSHA, WI 53144
Phone: Fax:
Organization Subpart
No
Authorized Official
CATHY DEAN
ADMINISTRATOR
Phone: (800) 485-8640
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207NS0135X
- Dermatology / Procedural Dermatology (Primary)
WI

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.