Organization
GREAT LAKES DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CATHY J DEAN (ADMINISTRATOR)
(800) 485-8640
Entity
Organization
Contact information
Practice address
1515 S GREENBAY RD, RACINE, WI 53406-4409
(262) 632-2074
(262) 632-2656
Mailing address
1515 S GREENBAY RD, RACINE, WI 53406-4409
(262) 632-2074
(262) 632-2656
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Enumeration date
10/23/2006
Last updated
08/22/2020
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