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DR. KYUNG AI MIREILLE CHAE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 683-5278
(920) 686-9674
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
67321-20
WI
207ND0900X
Dermatopathology Physician
67321-20
WI
207NP0225X
Pediatric Dermatology Physician
67321-20
WI
207ZD0900X
Dermatopathology (Pathology) Physician
67321-20
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
306311900
MN
Enumeration date
06/01/2005
Last updated
02/15/2021
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