Healthcare Provider Details

I. General information

NPI: 1659466779
Provider Name (Legal Business Name): MILWAUKEE SKIN CENTER,S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 W BROWN DEER RD
MILWAUKEE WI
53223-2078
US

IV. Provider business mailing address

7400 W BROWN DEER RD
MILWAUKEE WI
53223-2078
US

V. Phone/Fax

Practice location:
  • Phone: 414-355-2405
  • Fax: 414-355-6460
Mailing address:
  • Phone: 414-355-2405
  • Fax: 414-355-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number27925
License Number StateWI

VIII. Authorized Official

Name: DR. JAMES EDWARD BERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-355-2405