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	207NS0135X	Procedural Dermatology Physician
2	363L00000X	Nurse Practitioner
3	207ND0101X	MOHS-Micrographic Surgery Physician
4	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1790519320
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	:	316 SPANGLER DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2351
Country	:	US
Telephone Number	:	859-623-4241
Fax Number	:	859-623-4242

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

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	02/27/2026

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