NEW DERMATOLOGY GROUP LTD (NPI# 1235480112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235480112 |
| Entity Type | Organization |
| Organization Name | NEW DERMATOLOGY GROUP LTD |
| Practice Address |
2021 S Webster Ave Green Bay WI 54301-2257 |
| Mailing Address |
2221 S Webster Ave Suite 241 Green Bay WI 54301-2158 |
| Practice Telephone | 9209650345 |
| Practice Fax Number | 9202736011 |
| Mailing Telephone | 9209650345 |
| Mailing Fax Number | 9202736011 |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-12-13 |
| Authorized Official Name | KEVAN G LEWIS (OWNER) |
| Authorized Official Telephone | 9209650345 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207NI0002X |
Dermatology Specialization: Clinical & Laboratory Dermatological Immunology |
Allopathic & Osteopathic Physicians | ||
| N | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710321633 | New Dermatology Group Ltd | Dermatology | 440 Woodward Ave, Iron Mountain, MI 49801-4631 | 2013-04-22 |
| 1013350958 | New Dermatology Group Ltd | Dermatology | 704 S Webster Ave, Green Bay, WI 54301-3528 | 2013-04-10 |
| 1356784334 | New Dermatology Group Ltd | Dermatology | 1747 Shawano Ave, Green Bay, WI 54303-3243 | 2013-04-09 |
| Street Address |
2021 S WEBSTER AVE |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54301-2257 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992135420 | Deidre Pribek | Physician Assistant | 2021 S Webster Ave, Green Bay, WI 54301-2257 | 2013-11-19 |
| 1134400385 | Jason Orrin Davis | Physician Assistant | 2021 S Webster Ave, Green Bay, WI 54301-2257 | 2011-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386102465 | Parc Village Dental, LLC | Dentist | 2805 Libal Street, Suite A, Green Bay, WI 54301 | 2019-03-07 |
| 1598229478 | Shaina Marie Conner | Registered Nurse | 835 S Vanburen St, Green Bay, WI 54301 | 2019-01-25 |
| 1093298960 | Brown County | Case Management | 111 N. Jefferson Street, Green Bay, WI 54301 | 2018-09-07 |
| 1639609928 | Frontline Healthcare LLC | Specialist/Technologist, Other | 2221 S. Webster Ave. Suite 270, Greenbay, WI 54301 | 2017-06-19 |
| 1992242606 | Charmaine Rimple | Counselor | 526 South Monroe Avenue, Green Bay, WI 54301 | 2017-01-20 |
| 1962944819 | Rebecca Lucille Reinbold | Registered Nurse | 917 Catherine Street, Green Bay, WI 54301 | 2016-11-09 |
| 1730635061 | Melissa Kristof | Specialist/Technologist, Other | 1821 Sounth Webster Ave., Green Bay, WI 54301 | 2016-08-28 |
| 1255709747 | Vivian Sweetheart Bishop-cook | Counselor | 2920 South Webster Ave, Green Bay, WI 54301 | 2015-09-14 |
| 1881079960 | Chelsi S Weber | Registered Nurse | 2300 Riverside Dr., Ste 204, Green Bay, WI 54301 | 2015-07-30 |
| 1962816371 | Joelle M Hesse | Counselor | 630 Cherry St., Green Bay, WI 54301 | 2014-06-13 |
| Find all providers in zip 54301 | ||||
| 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 |
| 1194148379 | Michael J. Smullen, Md | Dermatology | 1239 W Mason St, Green Bay, WI 54303-2047 | 2014-01-24 |
| 1619981164 | Kolleen L Zimmermann | Dermatology | 715 Superior Rd Ste 120, Green Bay, WI 54311-7595 | 2006-07-28 |
| Find all providers in GREEN BAY | ||||
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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.