MEDICARE: MCGOEY DERMATOLOGY S.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1043951270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCGOEY DERMATOLOGY S.C.

Provider Business Mailing Address
First Line	:	832 MICHIGAN AVE
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53081-3438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	832 MICHIGAN AVE
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53081-3438
Country	:	US
Telephone Number	:	313-348-2643
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUZANNE MCGOEY
Credential	:	MD
Telephone Number	:	920-457-9634

Provider Enumeration Date	:	04/03/2022
Last Update Date	:	04/10/2026

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