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Contact Information

GREAT LAKES DERMATOLOGY
9555 76TH ST
SUITE 2600
PLEASANT PRAIRIE, WI53158-1984
 Phone: 800-485-8640
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Procedural Dermatology

207NS0135X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for GREAT LAKES DERMATOLOGY

NPI Number 1205041688
LBN Legal business name GREAT LAKES DERMATOLOGY
Authorized official CATHY DEAN - (ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 05/11/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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