Healthcare Provider Details

I. General information

NPI: 1700802923
Provider Name (Legal Business Name): DEBRA RENAE SCARLETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N LAKE DR SUITE 300
MILWAUKEE WI
53211-4528
US

IV. Provider business mailing address

788 N JEFFERSON ST SUITE 300/ATTN. KAAREN BUTZEN
MILWAUKEE WI
53202-3718
US

V. Phone/Fax

Practice location:
  • Phone: 414-298-7100
  • Fax: 414-298-7101
Mailing address:
  • Phone: 414-272-8950
  • Fax: 414-272-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number51384
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: