Organization
MICHAEL J. SMULLEN, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J. SMULLEN M.D. (SOLO PRACTITIONER)
(920) 499-0696
Entity
Organization
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
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30979400
—
WI
Enumeration date
01/24/2014
Last updated
01/24/2014
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