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	:	1538734066
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	:	2644 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-4902
Country	:	US
Telephone Number	:	405-254-5565
Fax Number	:	405-254-5569

Authorized Official
Title or Position	:	SR. DIRECTOR, PROVIDER ENROLLMENT
Name	:	DENISE L ANGER
Credential	:
Telephone Number	:	920-663-9022

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	05/26/2021

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Directions to “FOREFRONT DERMATOLOGY, S.C. ” Practice Location

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