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NPI Code Detail

MEDICARE: FOREFRONT DERMATOLOGY, S.C.

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 License Number License Number State
1207ND0101XMOHS-Micrographic Surgery Physician
2207NS0135XProcedural Dermatology Physician
3207N00000XDermatology Physician

General Provider Information

NPI Number : 1154815546
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 : 7720 US HIGHWAY 98 W STE 240
Second Line :
City : MIRAMAR BEACH
State : FL
Zip : 32550-7232
Country : US
Telephone Number : 850-502-5989
Fax Number : 850-266-6301
Authorized Official
Title or Position : PRESIDENT
Name : DR. BETSY J WERNLI
Credential : MD
Telephone Number : 920-482-0671
Provider Enumeration Date : 06/19/2018
Last Update Date : 12/24/2024

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