Organization
NEW DERMATOLOGY GROUP LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVAN LEWIS (OWNER)
(920) 965-0345
Entity
Organization
Contact information
Practice address
1747 SHAWANO AVE, GREEN BAY, WI 54303-3243
(920) 965-0345
Mailing address
2221 S WEBSTER AVE, STE 241, GREEN BAY, WI 54301-2158
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
53110-20
WI
207ND0101X
MOHS-Micrographic Surgery Physician
53110-20
WI
207ND0900X
Dermatopathology Physician
53110-20
WI
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
53110-20
WI
207NS0135X
Procedural Dermatology Physician
53110-20
WI
Other
Enumeration date
04/09/2013
Last updated
04/09/2013
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