Organization
NEW DERMATOLOGY GROUP LTD
Active
Parent organization
NEW DERMATOLOGY GROUP LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEW DERMATOLOGY GROUP LTD
Authorized official
KEVAN GERARD LEWIS MD (AUTHORIZED OFFICIAL)
(920) 965-0345
Entity
Organization
Contact information
Practice address
440 WOODWARD AVE, IRON MOUNTAIN, MI 49801-4631
(920) 965-0345
Mailing address
2021 S WEBSTER AVE, GREEN BAY, WI 54301-2257
(920) 965-0345
(920) 273-6011
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
04/22/2013
Last updated
04/22/2013
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