GREAT LAKES DERMATOLOGY (NPI# 1205041688) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205041688 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES DERMATOLOGY |
| Practice Address |
9555 76th St Suite 2600 Pleasant Prairie WI 53158-1984 |
| Practice Telephone | 8004858640 |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CATHY DEAN (ADMINISTRATOR) |
| Authorized Official Telephone | 8004858640 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
WI | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689757569 | Great Lakes Dermatology | Dermatology | 1515 S Greenbay Rd, Racine, WI 53406-4409 | 2006-10-23 |
| 1558576322 | Great Lakes Dermatology | Dermatology | 3601 30th Ave, Suite 210, Kenosha, WI 53144-1695 | 2007-05-14 |
| Street Address |
9555 76TH ST SUITE 2600 |
| City | PLEASANT PRAIRIE |
| State | WI |
| Zip Code | 53158-1984 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518915073 | United Occupational Medicine and Walk In Services, LLC | Emergency Medicine | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2006-05-05 |
| 1558971051 | Josephine Kristiansen | Pharmacist | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2020-08-09 |
| 1932727641 | Amy Ann Giese | Dietitian, Registered | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2020-07-09 |
| 1205453404 | Meghan Keefer | Nurse Practitioner | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2020-07-03 |
| 1396375762 | Sherri Lynn O'shea | Dietitian, Registered | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2020-01-24 |
| 1083179238 | Ihc-wound Care Services LLC | Emergency Medicine | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2019-02-01 |
| 1093292625 | Shannon L Yow | Nurse Practitioner | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2018-07-26 |
| 1447746805 | Jordon W. Thomsen | Physician Assistant | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2018-07-09 |
| 1780177048 | Rachel E Garnett | Physician Assistant | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2018-06-12 |
| 1750803474 | Matthew D Peterson | Physician Assistant | 9555 76th St, Pleasant Prairie, WI 53158-1984 | 2017-07-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497393516 | Aurora Surgery Centers, LLC | Clinic/Center | 12500 Aurora Drive, Pleasant Prairie, WI 53158 | 2019-12-19 |
| 1770144297 | Jill Plaisted | Counselor | 8503 75th Street, Suite A, Pleasant Prairie, WI 53158 | 2019-06-25 |
| 1427593847 | Douglas Marion Mcdaniel | Physical Therapy Assistant | 5932 85th St, Pleasant Prairie, WI 53158 | 2016-12-20 |
| 1477095602 | Molly Weber | Speech-Language Pathologist | 8717 82nd St, Apartment 109, Pleasant Prairie, WI 53158 | 2016-11-04 |
| 1568919165 | Nicole Taylor | Specialist/Technologist | 9321 8th Avenue, Pleasant Prairie, WI 53158 | 2016-09-01 |
| 1578980165 | Forefront Dermatology, S.c. | Dermatology | 9020 76th St, Suite E, Pleasant Prairie, WI 53158 | 2014-03-21 |
| 1750603130 | Shelley L Johnson | Nurse Practitioner | 9697 Saint Catherines Dr # 300, Pleasant Prairie, WI 53158 | 2010-02-25 |
| 1194054981 | Jennifer S Stevens | Behavioral Analyst | 10450 72nd Ave, Pleasant Prairie, WI 53158 | 2009-12-08 |
| 1932273398 | Pamela Anderson | Registered Nurse | 11202 79 Street, Pleasant Prairie, WI 53158 | 2006-11-20 |
| 1033205562 | Holly Seidman | Pharmacist | 1309 110th Street, Pleasant Prairie, WI 53158 | 2006-10-04 |
| Find all providers in zip 53158 | ||||
| Taxonomy Code | 207NS0135X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Procedural Dermatology |
| Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). |
| Notes: Source: American Board of Dermatology, 2007, www.abderm.org [1/1/2008: definition added, source added, title changed] Additional Resources: Some ABMS board certified dermatologists have completed a one-year ACGME approved fellowship in Procedural Dermatology, which has been offered since 2003. At this time the ABD does not offer subspecialty certification in Procedural Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578980165 | Forefront Dermatology, S.c. | Dermatology | 9020 76th St, Suite E, Pleasant Prairie, WI 53158 | 2014-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386194371 | Forefront Dermatology, S.c. | Dermatology | 7200 Washington Ave, Suite 100, Mount Pleasant, WI 53406 | 2016-10-13 |
| 1003238213 | Forefront Dermatology, S.c. | Dermatology | S.69 W.15472 Janesville Road, Muskego, WI 53150 | 2014-01-08 |
| 1225473713 | Forefront Dermatology, S.c. | Dermatology | 10303 N Port Washington Rd Ste 101, Mequon, WI 53092 | 2013-05-09 |
| 1689757569 | Great Lakes Dermatology | Dermatology | 1515 S Greenbay Rd, Racine, WI 53406-4409 | 2006-10-23 |
| 1982601704 | Steven L Armus | Dermatology | 6233 Bankers Rd, Suite 3, Mount Pleasant, WI 53403-9700 | 2005-07-07 |
| 1548716533 | Forefront Dermatology, S.c. | Dermatology | 3601 30th Ave, Suite 201, Kenosha, WI 53144 | 2016-08-30 |
| 1265988265 | Forefront Dermatology, S.c. | Dermatology | 7001 S Howell Ave, Suite 900, Oak Creek, WI 53154 | 2016-08-30 |
| 1659746931 | Forefront Dermatology, S.c. | Dermatology | 2600 65th Ave, Osceola Medical Center, Osceola, WI 54020 | 2015-12-11 |
| 1336516863 | Forefront Dermatology, S.c. | Dermatology | 100 County Road B, Shawano, WI 54166 | 2015-09-01 |
| 1043615164 | Forefront Dermatology, S.c. | Dermatology | 715 Superior Rd, Suite 120, Green Bay, WI 54311 | 2014-10-31 |
| Find all providers with the same taxonomy | ||||
| City | PLEASANT PRAIRIE |
| Zip Code | 53158 |
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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.