DERMATOLOGY CLINIC S.C. (NPI# 1427079516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427079516 |
| Entity Type | Organization |
| Organization Name | DERMATOLOGY CLINIC S.C. |
| Practice Address |
715 Superior Rd Ste 120 Green Bay WI 54311-7595 |
| Practice Telephone | 9204069803 |
| Practice Fax Number | 9204069934 |
| Mailing Telephone | 9204069803 |
| Mailing Fax Number | 9204069934 |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2012-04-19 |
| Authorized Official Name | MR. CHRIS L ZIMMERMANN (ASSISTANT TO THE PRESIDENT) |
| Authorized Official Telephone | 9204069803 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 2187-023 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21251100 | 05 |
| Street Address |
715 SUPERIOR RD STE 120 |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54311-7595 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619981164 | Kolleen L Zimmermann | Dermatology | 715 Superior Rd Ste 120, Green Bay, WI 54311-7595 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295333847 | Karen Ginnow | Pharmacist | Walmart #1908, 2292 Main St, Green Bay, WI 54311 | 2020-10-15 |
| 1639786551 | Maggie Hall | Dental Hygienist | 2633 Development Dr. Ste 40, Green Bay, WI 54311 | 2020-09-24 |
| 1295370807 | Jennifer Marie Arendt | Technician | 2970 Mossy Oak Cir #39, Green Bay, WI 54311 | 2019-11-07 |
| 1518508803 | Cheryl Ann Johnson | Specialist | 830 Edgewood Dr., Green Bay, WI 54311 | 2019-10-08 |
| 1124670898 | Robert H Wagner Family Dentist S.c. | Dentist | 2830 Curry Court, Suite 1, Green Bay, WI 54311 | 2019-07-12 |
| 1821659624 | The Salvation Army | Counselor | The Salvation Army Ray & Joan Kroc Center, 1315 Lime Kiln Road, Green Bay, WI 54311 | 2019-06-24 |
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1861916769 | Atlas Spinal Care | Chiropractor | 2069 Central Ct, Suite 11, Green Bay, WI 54311 | 2017-08-01 |
| 1851844161 | Green Bay Family Dental LLC | Dentist | 2609 Development Dr., Green Bay, WI 54311 | 2016-08-03 |
| 1710382809 | Betsy Hoida | Pharmacist | 2485 Greenbrier Rd., Green Bay, WI 54311 | 2014-10-31 |
| Find all providers in zip 54311 | ||||
| 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.