DR. MICHAEL JAMES SMULLEN (NPI# 1023020120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023020120 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL JAMES SMULLEN |
| Credential | 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 | 2006-08-13 |
| Last Update Date | 2010-09-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | WI16879 | WI | Allopathic & Osteopathic Physicians |
| Y | 207ND0900X |
Dermatology Specialization: Dermatopathology |
WI16879 | WI | 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 |
|---|---|---|---|---|
| 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 |
| 1194148379 | Michael J. Smullen, Md | Dermatology | 1239 W Mason St, Green Bay, WI 54303-2047 | 2014-01-24 |
| 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 | 207ND0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Dermatopathology |
| A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/; American Osteopathic Board of Dermatology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Dermatology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376526095 | Eric Morgan Hanson | Dermatology | 1515 Randolph Ct, Manitowoc, WI 54220-8345 | 2005-11-28 |
| 1366776601 | Fleming Dermatopathology, LLC | Dermatology | 1661 N Water St, #500, Milwaukee, WI 53202-2085 | 2009-09-18 |
| 1578726717 | Kelli Ann Hutchens | Dermatology | 801 York St, Manitowoc, WI 54220-4630 | 2008-07-08 |
| 1457554917 | Willmar Davison Patino Cadavid | Dermatology | 801 York St, Manitowoc, WI 54220-4630 | 2007-06-11 |
| 1932209129 | Ling Xia | Dermatology | 801 York St, Manitowoc, WI 54220-4630 | 2006-09-25 |
| 1073555033 | Fox Cities Dermatology & Skin Cancer Center, Sc | Dermatology | 188 Rockwood Ln, Neenah, WI 54956 | 2006-06-12 |
| 1578515904 | Forefront Dermatology, S.c. | Dermatology | 1515 Randolph Ct, Manitowoc, WI 54220 | 2006-05-16 |
| 1730140245 | Andreas Friedl | Dermatology | 600 Highland Ave, Madison, WI 53792 | 2006-04-01 |
| 1821059346 | Wei Huang | Dermatology | 600 Highland Ave, Madison, WI 53792 | 2006-04-01 |
| 1609835669 | B Jack Longley | Dermatology | 451 Junction Rd, Madison, WI 53717 | 2006-03-20 |
| 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.