Organization
GREAT LAKES DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY DEAN (ADMINISTRATOR)
(800) 485-8640
Entity
Organization
Contact information
Practice address
3601 30TH AVE, SUITE 210, KENOSHA, WI 53144-1695
(262) 658-2594
Mailing address
3610 30TH AVENUE, SUITE 210, KENOSHA, WI 53144
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
WI
Other
Enumeration date
05/14/2007
Last updated
08/22/2020
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