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
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1679029672
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	:	920-663-9005
Fax Number	:	920-682-0970

Provider Business Practice Location Address
First Line	:	8532 W CAPITOL DR
Second Line	:	SUITE 202
City	:	MILWAUKEE
State	:	WI
Zip	:	53222
Country	:	US
Telephone Number	:	920-663-9005
Fax Number	:	920-682-0970

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	05/17/2018

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