Healthcare Provider Details

I. General information

NPI: 1760870851
Provider Name (Legal Business Name): FOREFRONT DERMATOLOGY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 10TH STREET, SW SUITE 290
CEDAR RAPIDS IA
52403
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 920-663-9016
  • Fax: 920-684-1439
Mailing address:
  • Phone: 866-630-9882
  • Fax: 920-682-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BETSY J WERNLI
Title or Position: PRESIDENT
Credential: MD
Phone: 920-482-0671