Organization
FOX VALLEY DERMATOLOGY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER LENZ (OFFICE MANAGER)
(920) 426-2211
Entity
Organization
Contact information
Practice address
515 S WASHBURN ST, SUITE 204, OSHKOSH, WI 54904-7975
(920) 232-1130
Mailing address
3420 JACKSON ST, SUITE E, OSHKOSH, WI 54901-8144
(920) 426-2211
(920) 426-2231
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
42905020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34045300
—
WI
Enumeration date
07/28/2006
Last updated
08/22/2020
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