Healthcare Provider Details

I. General information

NPI: 1194711853
Provider Name (Legal Business Name): AFFILIATED DERMATOLOGISTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 W NATIONAL AVE SUITE 190
NEW BERLIN WI
53151-4494
US

IV. Provider business mailing address

13800 W NORTH AVE STE 100
BROOKFIELD WI
53005-4977
US

V. Phone/Fax

Practice location:
  • Phone: 262-754-4488
  • Fax: 262-754-4940
Mailing address:
  • Phone: 262-754-4488
  • Fax: 262-754-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATHLEEN SARAH STOKES
Title or Position: PRESIDENT
Credential: MD
Phone: 262-754-4488