Individual
DR. MICHAEL JAMES SMULLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1239 W MASON ST, GREEN BAY, WI 54303-2047
(920) 499-0696
(920) 499-0697
Mailing address
1239 W MASON ST, GREEN BAY, WI 54303-2047
(920) 499-0696
(920) 499-0697
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
WI16879
WI
207ND0900X
Dermatopathology Physician
Primary
WI16879
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30979400
—
WI
Enumeration date
08/13/2006
Last updated
09/22/2010
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