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Organization

GREAT LAKES DERMATOLOGY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CATHY DEAN (ADMINISTRATOR)
(800) 485-8640
Entity
Organization

Contact information

Practice address
9555 76TH ST, SUITE 2600, PLEASANT PRAIRIE, WI 53158-1984
(800) 485-8640
Mailing address
9555 76TH ST, SUITE 2600, PLEASANT PRAIRIE, WI 53158-1984

Taxonomy

Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
WI

Other

Enumeration date
05/11/2007
Last updated
08/22/2020
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