Healthcare Provider Details

I. General information

NPI: 1649664434
Provider Name (Legal Business Name): MERIT DERMATOLOGY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 BANKERS RD SUITE 20
MOUNT PLEASANT WI
53403-9700
US

IV. Provider business mailing address

6233 BANKERS RD SUITE 3
MOUNT PLEASANT WI
53403-9700
US

V. Phone/Fax

Practice location:
  • Phone: 262-898-4400
  • Fax:
Mailing address:
  • Phone: 262-898-4419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES G DELIS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 847-414-7010