Organization
GREAT LAKES PLASTIC SURGERY SC
Active
Other names
Jeffrey A Herold MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY A HEROLD MD (PLASTIC SURGEON)
(920) 803-1598
Entity
Organization
Contact information
Practice address
1526 N TAYLOR DR, SHEBOYGAN, WI 53081-1927
(920) 803-1598
(920) 803-1599
Mailing address
1526 N TAYLOR DR, SHEBOYGAN, WI 53081-1927
(920) 803-1598
(920) 803-1599
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
39578020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32429800
—
WI
Enumeration date
02/13/2006
Last updated
01/11/2010
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