Healthcare Provider Details

I. General information

NPI: 1497150510
Provider Name (Legal Business Name): FOREFRONT DERMATOLOGY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SPRING ST
JEFFERSONVILLE IN
47130
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-8622
  • Fax: 812-282-8622
Mailing address:
  • Phone: 866-630-9882
  • Fax: 920-683-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BATSY J WERNLI
Title or Position: PRESIDENT
Credential: MD
Phone: 960-482-0671