Organization
DERMATOLOGY SERVICES, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIDNEY HERSZENSON MD (OWNER)
(414) 258-3500
Entity
Organization
Contact information
Practice address
3077 N MAYFAIR RD, SUITE 305, WAUWATOSA, WI 53222-4305
(414) 258-3500
(414) 258-3501
Mailing address
3077 N MAYFAIR RD, SUITE 305, WAUWATOSA, WI 53222-4305
(414) 258-3500
(414) 258-3501
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
18537
WI
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21303900
—
WI
01
—
CS0892
RR MEDICARE
—
Enumeration date
05/04/2006
Last updated
06/04/2012
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