Organization
ACADEMIC DERMATOLOGY & MOHS SURGERY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANISH J GHARIA MD (OWNER/PRESIDENT)
(414) 258-3376
Entity
Organization
Contact information
Practice address
201 N MAYFAIR RD, SUITE 550, WAUWATOSA, WI 53226-4216
(414) 258-3376
(414) 475-6647
Mailing address
4555 W SCHROEDER DR, SUITE 170, MILWAUKEE, WI 53223-1475
(414) 365-3210
(414) 365-3225
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34248400
—
WI
Enumeration date
11/09/2007
Last updated
03/24/2008
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