Organization
DERMATOLOGY CLINIC S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS L ZIMMERMANN PHD (ASSISTANT TO THE PRESIDENT)
(920) 406-9803
Entity
Organization
Contact information
Practice address
715 SUPERIOR RD STE 120, GREEN BAY, WI 54311-7595
(920) 406-9803
(920) 406-9934
Mailing address
715 SUPERIOR RD STE 120, GREEN BAY, WI 54311-7595
(920) 406-9803
(920) 406-9934
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
363A00000X
Physician Assistant
2187-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21251100
—
WI
Enumeration date
07/22/2006
Last updated
04/19/2012
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