MICHAEL J. SMULLEN, MD (NPI# 1194148379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194148379 |
| Entity Type | Organization |
| Organization Name | MICHAEL J. SMULLEN, MD |
| Practice Address |
1239 W Mason St Green Bay WI 54303-2047 |
| Practice Telephone | 9204990696 |
| Practice Fax Number | 9204990697 |
| Mailing Telephone | 9204990696 |
| Mailing Fax Number | 9204990697 |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2014-01-24 |
| Authorized Official Name | DR. MICHAEL J. SMULLEN (SOLO PRACTITIONER) |
| Authorized Official Telephone | 9204990696 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 30979400 | 05 |
| Street Address |
1239 W MASON ST |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-2047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023020120 | Michael James Smullen | Dermatology | 1239 W Mason St, Green Bay, WI 54303-2047 | 2006-08-13 |
| 1477112761 | Kelsey Gaedtke | Chiropractor | 1239 W Mason St, Green Bay, WI 54303-2047 | 2019-06-10 |
| 1669035606 | Dallas Ryan Topping-koppes | Chiropractor | 1239 W Mason St, Green Bay, WI 54303-2047 | 2019-04-16 |
| 1609357565 | Rebecca L Brown | Chiropractor | 1239 W Mason St, Green Bay, WI 54303-2047 | 2018-08-28 |
| 1578049029 | Nadine M Illichmann | Chiropractor | 1239 W Mason St, Green Bay, WI 54303-2047 | 2018-07-18 |
| 1164934220 | Sarah Nordbeck | Chiropractor | 1239 W Mason St, Green Bay, WI 54303-2047 | 2017-10-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821298324 | Semyon Zarkhin | Dermatology | 2617 Development Dr, Green Bay, WI 54311-4240 | 2007-07-23 |
| 1497970560 | Kevan G Lewis | Dermatology | 3059 Voyager Dr, Green Bay, WI 54311-8303 | 2007-04-16 |
| 1609946292 | Rene Martin Earles | Dermatology | 2221 S Webster Ave, Ste 241, Green Bay, WI 54301-2158 | 2006-11-09 |
| 1013022292 | Frances Stahl Ballo | Dermatology | 2617 Development Drive, Green Bay, WI 54311-4240 | 2006-08-20 |
| 1023020120 | Michael James Smullen | Dermatology | 1239 W Mason St, Green Bay, WI 54303-2047 | 2006-08-13 |
| 1548264336 | Paul Michael Stover | Dermatology | 2806 Riverview Dr, Green Bay, WI 54313-6717 | 2005-06-09 |
| 1780100180 | Baycare Clinic, LLP | Dermatology | 2605 Development Dr, Green Bay, WI 54311-4240 | 2017-08-17 |
| 1285047373 | Daniel P Hertel | Dermatology | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2014-06-05 |
| 1619981164 | Kolleen L Zimmermann | Dermatology | 715 Superior Rd Ste 120, Green Bay, WI 54311-7595 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174016596 | Dermatology and Cosmetic Physicians, Sc | Dermatology | W5192 Rienzi Rd, Fond Du Lac, WI 54935-9603 | 2018-06-11 |
| 1194248013 | Kyle Erick Rudningen | Dermatology | Uw Hosptials & Clinics 600 Highland Ave, Madison, WI 53792 | 2017-07-23 |
| 1194255521 | Rhonda Ganansky | Dermatology | W1383 N Bloomfield Rd, Lake Geneva, WI 53147-4429 | 2017-06-18 |
| 1356891402 | Forefront Dermatology, S.c. | Dermatology | 1515 S Green Bay Rd, Racine, WI 53406 | 2016-10-12 |
| 1982066239 | Margaret Coleman Maxi | Dermatology | 188 Rockwood Ln Ste A, Neenah, WI 54956-1983 | 2016-03-25 |
| 1447612312 | Andrew C Duncanson | Dermatology | 510 N 17th Ave Ste C, Wausau, WI 54401-4281 | 2016-03-22 |
| 1225411481 | Gabriela A Maloney | Dermatology | 17100 W North Ave Ste 200, Brookfield, WI 53005-4489 | 2015-07-07 |
| 1043604424 | Marthe Ngongang Dika | Dermatology | 10500 W Loomis Rd Ste 110, Franklin, WI 53132-8030 | 2015-03-24 |
| 1902205206 | Affiliated Dermatologists | Dermatology | N96w17035 Division Rd, Suite A, Germantown, WI 53022-6419 | 2014-08-22 |
| 1568882793 | Kassandra E Holzem | Dermatology | 195 Discovery Dr, Brookfield, WI 53045 | 2014-04-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.