MEDICARE: FOREFRONT DERMATOLOGY, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207ND0101X	MOHS-Micrographic Surgery Physician
2	207NS0135X	Procedural Dermatology Physician
3	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1043107477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREFRONT DERMATOLOGY, S.C.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	505 W HOMER ST STE 201
Second Line	:
City	:	SALEM
State	:	IN
Zip	:	47167-1698
Country	:	US
Telephone Number	:	812-883-0024
Fax Number	:	812-883-8574

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BETSY J WERNLI
Credential	:	MD
Telephone Number	:	920-482-0671

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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