Organization
NEW DERMATOLOGY GROUP LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVAN G LEWIS MD (OWNER)
(920) 965-0345
Entity
Organization
Contact information
Practice address
2021 S WEBSTER AVE, GREEN BAY, WI 54301-2257
(920) 965-0345
(920) 273-6011
Mailing address
2221 S WEBSTER AVE, SUITE 241, GREEN BAY, WI 54301-2158
(920) 965-0345
(920) 273-6011
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
10/02/2012
Last updated
12/13/2012
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