Healthcare Provider Details

I. General information

NPI: 1992713929
Provider Name (Legal Business Name): BAYVIEW DERMATOLOGY & COSMETIC SURGERY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 W CLEMENT AVE SUITE 100
BAYVIEW WI
53207
US

IV. Provider business mailing address

4555 WEST SCHROEDER DRIVE SUITE 170
MILWAUKEE WI
53223
US

V. Phone/Fax

Practice location:
  • Phone: 414-769-0040
  • Fax: 414-769-0048
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NEAL N BHATIA
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 414-769-0040