Organization
GREAT LAKES DERMATOLOGY SC
Active
Other names
ASCEND DERMATOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY K OLSON (MANAGER OF COMPLIANCE)
(262) 989-4400
Entity
Organization
Contact information
Practice address
6233 BANKERS RD, SUITE 3, MOUNT PLEASANT, WI 53403-9700
(262) 898-4400
(262) 898-4423
Mailing address
6233 BANKERS RD STE 3, MOUNT PLEASANT, WI 53403-9700
(262) 898-4400
(262) 898-4423
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CH7592
—
WI
Enumeration date
11/28/2006
Last updated
05/26/2015
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