Individual
DR. LISA LYNNE BUTENHOFF CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 SCHEURING RD, DE PERE, WI 54115-1067
(920) 964-0229
(920) 686-9674
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
50518-20
WI
207N00000X
Dermatology Physician
MD430734
PA
207ND0101X
MOHS-Micrographic Surgery Physician
4301105435
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124145040
—
WI
01
—
171400016
MEDICARE
WI
01
—
382000020
MEDICARE
WI
01
—
50518-020
STATE LICENSE
WI
01
—
P00720349
RAILROAD MEDICARE
WI
Enumeration date
03/24/2007
Last updated
12/11/2024
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